1Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
2Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
3Division of Vascular and Interventional Radiology, Department of Radiology, Emory University School of Medicine, Atlanta, Georgia.
4Division of Vascular and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
5Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: firstname.lastname@example.org.
Purpose: To systematically review cost research in interventional radiology (IR) published since the Society of Interventional Radiology Research Consensus Panel on Cost in December 2016.
Materials and methods: A retrospective assessment of cost research in adult and pediatric IR since December 2016 to July 2022 was conducted. All cost methodologies, service lines, and IR modalities were screened. Analyses were reported in a standardized fashion to include service lines, comparators, cost variables, analytical processes, and databases used.
Results: There were 62 studies published, with most from the United States (58%). Incremental cost-effectiveness ratio, quality-adjusted life-years, and time-driven activity-based costing (TDABC) analyses were performed in 50%, 48%, and 10%, respectively. The most frequently reported service line was interventional oncology (21%). No studies on venous thromboembolism, biliary, or IR endocrine therapies were found. Cost reporting was heterogeneous owing to varying cost variables, databases, time horizons, and willingness-to-pay (WTP) thresholds. IR therapies were more cost-effective than their non-IR counterparts for treating hepatocellular carcinoma ($55,925 vs $211,286), renal tumors ($12,435 vs $19,399), benign prostatic hyperplasia ($6,464 vs $9,221), uterine fibroids ($3,772 vs $6,318), subarachnoid hemorrhage ($1,923 vs $4,343), and stroke ($551,159 vs $577,181). TDABC identified disposable costs contributing most to total IR costs: thoracic duct embolization (68%), ablation (42%), chemoembolization (30%), radioembolization (80%), and venous malformations (75%).
Conclusions: Although much of the contemporary cost-based research in IR aligned with the recommendations by the Research Consensus Panel, gaps remained in service lines, standardization of methodology, and addressing high disposable costs. Future steps include tailoring WTP thresholds to nation and health systems, cost-effective pricing for disposables, and standardizing cost sourcing methodology.