Cost Analysis of Intravascular Ultrasound Guidance for Transjugular Intrahepatic Portosystemic Shunt Creation

Brian P Triana; Abby Britt; Katherine Whited; Chauncy Handran; Vikram F Gupta; Waleska M Pabon-Ramos; Charles Y Kim; Neil D Ray; Jonathan G Martin; James Ronald

doi:10.1016/j.jvir.2025.01.029

Cost Analysis of Intravascular Ultrasound Guidance for Transjugular Intrahepatic Portosystemic Shunt Creation

J Vasc Interv Radiol. 2025 Jan 21:S1051-0443(25)00041-7. doi: 10.1016/j.jvir.2025.01.029. Online ahead of print.

Authors

Affiliations

¹ Division of Vascular & Interventional Radiology, Department of Radiology, Duke University Hospital, Durham, NC 27710.
² Interventional Radiology, Prisma Health Greenville Memorial Hospital, 701 Grove Road, Greenville, SC 29605.
³ Department of Anesthesiology, Duke University Hospital, Durham, NC 27710.
⁴ Division of Vascular & Interventional Radiology, Department of Radiology, Duke University Hospital, Durham, NC 27710. Electronic address: james.ronald@duke.edu.

PMID: 39848317
DOI: 10.1016/j.jvir.2025.01.029

Abstract

Purpose: To compare costs of intravascular ultrasound (IVUS)-guided transjugular intrahepatic portosystemic shunt (TIPS) creation versus non-IVUS-guided TIPS creation, accounting for differences in procedure time and resource utilization.

Materials and methods: This single institution retrospective study estimated procedure time and resource utilization from 157 consecutive elective TIPS creation procedures, of which 91 were IVUS-guided and 66 were non-IVUS-guided. Differences in procedure costs were derived using time-driven activity-based costing. The difference in post-TIPS creation length of hospital stay was included in overall episode of care cost estimates.

Results: IVUS-guided TIPS creation was 45.5 minutes faster (p<0.001) and required 35.2 mL less contrast material (p<0.001) leading to savings of $325.34 on staffing, $58.21 on medications, and $76.59 on equipment usage. However, with $2,100 single-use disposable catheters, IVUS guidance was $1,484.96 more costly per procedure. Following TIPS creation mean length of hospital stay was 1.3 days after IVUS-guided procedures versus 2.1 days after non-IVUS-guided procedures (p=0.001). With an estimated cost of $2,677 per hospital day, there was an overall savings of $656.64 with IVUS-guided TIPS creation.

Conclusion: Improved procedural metrics during TIPS creation alone are unlikely to offset the costs of IVUS guidance. However, based on improvements in immediate post-TIPS creation clinical outcomes, which may translate into shorter hospitalization, IVUS guidance is likely to reduce overall costs for the episode of care related to TIPS creation.