• Besma J Nejim, Sophie Wang, Isibor Arhuidese, Tammam Obeid, Husain Nader Alshaikh, Hanaa Dakour Aridi, Satinderjit Locham, and Mahmoud B Malas.
• Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
• J. Vasc. Surg. 2018 Apr 1; 67 (4): 1170-1180.e4.

BackgroundLower extremity bypass (LEB) remains the gold standard revascularization procedure in patients with peripheral arterial disease. The cost of LEB substantially varies based on patient's characteristics and comorbidities. The aim of this study was to assess regional variation in infrainguinal LEB cost and to identify the specific health care expenditures per service that are associated with the highest cost in each region.MethodsWe identified adult patients who underwent infrainguinal LEB in the Premier database between June 2009 and March 2015. Generalized linear regression models were used to report differences between regions in total in-hospital cost and service-specific cost adjusting for patient's demographics, clinical characteristics, and hospital factors.ResultsA total of 50,131 patients were identified. The median in-hospital cost was $13,259 (interquartile range, $9308-$19,590). The cost of LEB was significantly higher in West and Northeast regions with a median cost of nearly $16,000. The high cost in the Northeast region was driven by the fixed (indirect) cost, whereas the driver of the high cost in the West region was the variable (direct) cost. The adjusted total in-hospital cost was significantly higher in all regions compared with the South (mean difference, West, $3752 [95% confidence interval (CI), 3477-4027]; Northeast, $2959 [95% CI, 2703-3216]; Midwest, 1586 [95% CI, 1364-1808]).ConclusionsIn this study, we show the marked regional variability in LEB costs. This disparity was independent from patient clinical condition and hospital factors. Cost inequality across the US represents a financial burden on both the patient and the health system.Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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