Assessment of Change in Treatment Modalities Utilized for Chronic Venous Disease and Elimination of Axial Vein Reflux

Tuesday, March 7, 2023

3:45 PM – 3:54 PM

Location: Phoenix Convention Center, 222C

Presenting Author(s)

Eshani J. Choksi, BS

D.O. Candidate
Rowan University School of Osteopathic Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

DP

Darshan J. Parikh, MD

Integrated Interventional Radiology Resident
Thomas Jefferson University Hospital
Ronald Winokur, MD

Director
Weill Cornell Vein Treatment Center
Allison L. Tan, MD (she/her/hers)

Assistant Professor
Thomas Jefferson University
RF

Robert W. Ford, MD

Assistant Professor
Thomas Jefferson University Hospital
JW

Jonathan Weinstein, MD

IR Faculty
Northwell Health

Disclosure(s):

Eshani J. Choksi, BS: No financial relationships to disclose

Ronald Winokur, MD: BD/Bard: Speaking and Teaching (Ongoing); Cordis: Consultant (Ongoing); Endovascular Engineering: Consultant (Ongoing); Inari medical: Consultant (Ongoing), Speaking and Teaching (Ongoing); Kalmaro Vascular: Consultant (Ongoing); Medtronic: Consultant (Ongoing), Speaking and Teaching (Ongoing); Mentice: Consultant (Ongoing); Penumbra: Speaking and Teaching (Ongoing)

Allison L. Tan, MD: Becton Dickenson: Consultant (Ongoing), Speaking and Teaching (Ongoing)

Purpose: Evaluate trends in utilization of surgical vs. endovascular interventions for treatment of chronic venous disease (CVD) in the Medicare population and trends in utilization of endovascular interventions based on technique and provider specialty.

Materials and Methods: Medicare Part B Physician Supplier Procedure Summary (PSPS) data from 2010-2018 was obtained. All claims for CVD treatment were identified using HCPCS codes, and Medicare physician specialty codes were used to identify the provider specialty associated with a claim. Aggregate procedure volumes were converted into a utilization rate per 1,000,000 Medicare beneficiaries. Total percent change in utilization rates was calculated. Market share was also determined by the percentage of procedures performed by the specific provider group.

Results: From 2010-2018, overall utilization of CVD treatments increased by 58%, largely due to growing utilization of endovascular treatments, which increased by 68%. Concomitantly, there was a 66% decrease in surgical treatments. Among endovascular therapies, there was a 5% decrease in utilization of endovascular laser ablation, a 38% increase of traditional sclerotherapy, and a 136% increase of endovascular radiofrequency ablation. The utilization of laser ablation, traditional sclerotherapy and endovascular ablation plateaued in 2016 with the advent of Clarivein, and subsequently decreased in 2017-2018 with the advent of Varithena/Venaseal. Trend analysis of endovascular interventions showed that utilization rate increased across most specialties between 2010 to 2018, with the largest growth seen in cardiology by 427%. There was an increase amongst radiologists by 141%, and the smallest increase was seen in general surgery of 20%. While vascular and general surgery encompassed nearly 79% of market share for traditional surgical intervention, there was a steady decline in utilization rates by 41% and 75%, respectively.

Conclusion: Endovascular treatment for CVD remains predominant in the Medicare population, with increased utilization and a concomitant decrease in legacy surgical methods. Evolution in provider training and improved outcomes has shifted the market share of specialties performing treatments. Further investigation is warranted to understand trends in Medicare utilization of non-thermal ablation methods by provider specialties with the advent of newer treatment modalities.