Divya Kishore1, Michal Horný1,2, Andrew B Rosenkrantz3, Jennifer Hemingway4, Danny R Hughes4,5, Richard Duszak1. 1. 1 Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Ste D112, Atlanta, GA 30322. 2. 2 Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. 3. 3 NYU Langone Medical Center, New York, NY. 4. 4 Harvey L. Neiman Health Policy Institute, Reston, VA. 5. 5 School of Economics, Georgia Institute of Technology, Atlanta, GA.
Abstract
OBJECTIVE: Recent research on inferior vena cava (IVC) filter utilization in the United States has largely focused on national aggregate Medicare datasets, showing recent declines. Whether these national Medicare trends are generalizable across regions and payer populations is unknown. We studied recent state-level variation in IVC filter utilization across both Medicare and private insurance populations. MATERIALS AND METHODS: Using large individual beneficiary claims-level Medicare research identifiable files and a proprietary U.S. research database of the commercially insured population, we identified all billed IVC filter placement procedures performed between 2009 and 2015. We compared population-adjusted utilization rates by state and payer type. RESULTS: Between 2009 and 2015, IVC filter utilization across the United States declined by 36.3% (from 177.9 to 113.3 procedures per 100,000 beneficiaries) in the Medicare population and by 26.6% (from 32.7 to 24.0 procedures per 100,000 beneficiaries) in the privately insured population. For the Medicare population, state-level utilization rates varied 5.2-fold, from 48.4 to 251.3 procedures per 100,000 beneficiaries in Alaska and New Jersey, respectively. For the private insurance population, rates varied 5.5-fold, from 10.8 to 59.5 procedures per 100,000 beneficiaries in Oregon and Michigan, respectively. Nationally, utilization in the Medicare population was 5.0 times higher than that in the private insurance population (range by state, from 2.0 times higher in Hawaii to 11.1 times higher in Utah). Despite the national decline, utilization in Medicare and private insurance populations increased in five and seven states, respectively. State-level IVC filter utilization rates for the Medicare population correlated strongly with those for the privately insured population (r = 0.74; p < 0.001). In both the Medicare and privately insured populations, utilization rates correlated moderately with beneficiary age (r = 0.44 and r = 0.50, respectively; p < 0.001 for both). CONCLUSION: IVC filter utilization rates vary dramatically by state and payer population, and they likely depend in part on the age of the covered population. To better identify demographic and socioeconomic drivers of utilization, future research should prioritize nonaggregate multipayer claims-level approaches.
OBJECTIVE: Recent research on inferior vena cava (IVC) filter utilization in the United States has largely focused on national aggregate Medicare datasets, showing recent declines. Whether these national Medicare trends are generalizable across regions and payer populations is unknown. We studied recent state-level variation in IVC filter utilization across both Medicare and private insurance populations. MATERIALS AND METHODS: Using large individual beneficiary claims-level Medicare research identifiable files and a proprietary U.S. research database of the commercially insured population, we identified all billed IVC filter placement procedures performed between 2009 and 2015. We compared population-adjusted utilization rates by state and payer type. RESULTS: Between 2009 and 2015, IVC filter utilization across the United States declined by 36.3% (from 177.9 to 113.3 procedures per 100,000 beneficiaries) in the Medicare population and by 26.6% (from 32.7 to 24.0 procedures per 100,000 beneficiaries) in the privately insured population. For the Medicare population, state-level utilization rates varied 5.2-fold, from 48.4 to 251.3 procedures per 100,000 beneficiaries in Alaska and New Jersey, respectively. For the private insurance population, rates varied 5.5-fold, from 10.8 to 59.5 procedures per 100,000 beneficiaries in Oregon and Michigan, respectively. Nationally, utilization in the Medicare population was 5.0 times higher than that in the private insurance population (range by state, from 2.0 times higher in Hawaii to 11.1 times higher in Utah). Despite the national decline, utilization in Medicare and private insurance populations increased in five and seven states, respectively. State-level IVC filter utilization rates for the Medicare population correlated strongly with those for the privately insured population (r = 0.74; p < 0.001). In both the Medicare and privately insured populations, utilization rates correlated moderately with beneficiary age (r = 0.44 and r = 0.50, respectively; p < 0.001 for both). CONCLUSION: IVC filter utilization rates vary dramatically by state and payer population, and they likely depend in part on the age of the covered population. To better identify demographic and socioeconomic drivers of utilization, future research should prioritize nonaggregate multipayer claims-level approaches.
Authors: Brett J Carroll; Sebastian E Beyer; Tyler Mehegan; Andrew Dicks; Abby Pribish; Andrew Locke; Anuradha Godishala; Kevin Soriano; Jaya Kanduri; Kelsey Sack; Inbar Raber; Cara Wiest; Isabel Balachandran; Mason Marcus; Louis Chu; Margaret M Hayes; Jeff L Weinstein; Kenneth A Bauer; Eric A Secemsky; Duane S Pinto Journal: Am J Med Date: 2020-05-19 Impact factor: 4.965
Authors: Matthew R Augustine; Erica M Knavel Koepsel; Lisa G Peterson; Laurie Rupkalvis; Ann Comstock; Ian McPhail; Robert D McBane; Haraldur Bjarnason; Damon E Houghton Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-09-03