Table 2.
Review of comparative economic studies of IR procedures. Only comparative studies on IR procedures investigating surgical or medical alternatives are included in this review.
| Procedure | Reference | Comparison | Method | Statistically significant findings |
|---|---|---|---|---|
| Whole body (systemic) | ||||
| Biopsy | Brownleee, et al., 2020 (180) | Inpatient vs. outpatient | Retrospective | Safe and cost effective for outpatient procedure |
| Biopsy | Na, et al., 2020 (181) | Surgical biopsy | Retrospective | Percutaneous biopsies were cheaper w/ reduced hospital stays vs. surgical |
| Biopsy | Pistolese, et al., 2012 (182) | Surgical biopsy | Retrospective | Breast surgical biopsy cheaper vs. vacuum assisted biopsy w/ equal diagnostic value |
| Biopsy | Lachar, et al, 2007 (183) | Surgical biopsy | Retrospective | Needle core is cheaper than open biopsy for lymphomas |
| Biopsy | Silverman, et al., 1998 (184) | Surgical biopsy | Retrospective | Abdominal biopsy cheaper than surgical |
| Biopsy | Tsai, et al., 2020 (185) | Surgical biopsy | Retrospective | Breast surgical biopsy cheaper vs. vacuum assisted biopsy w/ equal diagnostic value |
| Biopsy | Sutton, et al., 2013 (186) | Surgical biopsy | Model based systematic review | Lymph node biopsy cost effective and equal outcome to inguinofemoral lymphadenectomy |
| Biopsy | Gruber, et al., 2008 (187) | Surgical biopsy | Meta-analysis | Needle core is cheaper than open biopsy |
| Drains | Botana-Rial, et al., 2021 (188) | Paracentesis | Systematic review | Indwelling catheter for malignant effusion increased quality of life in cost effective manor |
| Vascular | ||||
| Chest port insertion | LaRoy, et al., 2015 (189) | IR vs. OR suite placement | Retrospective | IR suites were cheaper with comparable OR suite placement outcomes |
| Implantable venous access device insertion | Hancock-Howard, et al., 2010 (136) | Surgical placement | Retrospective cohort | IR placement in pediatric patients was cheaper than operative placement |
| TIVAD | Martin, et al., 2022 (190) | OR vs. IR | Retrospective | TIVAD placement was 16% more expensive on average in OR vs. IR (P < 0.01) |
| IVC filter placement & removal | Makary, et al., 2018 (38) | OR vs. IR | Retrospective cohort | IR used half the fluoroscopy time vs. OR (P = 0.02) for filter removal, direct costs of OR 20% > than IR (P = 0.01) filter placement |
| Splenic artery embolization | Kanters, et al., 2021 (191) | Embolization vs. splenectomy | Retrospective cohort | Embolization intervention was more cost effective and increased QALY in splenectomy |
| Hepatobiliary | ||||
| Transjugular intrahepatic portosystemic shunt (TIPS) | Russo, et al., 2000 (72) | Endoscopic sclerotherapy | Retrospective | TIPS was more cost effective per bleed with lower recurrent bleed rates |
| Radiofrequency ablation | Cucchetti, et al., 2013 (192) | Surgical resection vs. RFA | Markov model | For a single lesion <2 cm or multiple <3 cm, RFA was the most cost effective therapeutic. |
| Radiofrequency ablation | Spolverato, et al., 2015 (193) | Surgical resection vs. RFA vs. transplant | Cost analysis | Milan criteria and Child-Pugh A cirrhosis patients with RFA or resection had more cost-effective outcomes than transplantation |
| Tunneled peritoneal cavity | Bohn, et al., 2015 (68) | Paracentesis | Sost-minimization | Peritoneal catheter saves costs for malignant ascites after an average of 83 days |
| Tunneled peritoneal cavity | Sennafalt, et al., 2002 (194) | Hemodialysis | Decision tree model | The cost per quality adjusted life year was less for peritoneal dialysis |
| Endocrine | ||||
| Parathyroid venous sampling | Sato, et al., 2015 (195) | Markov modelling | Standard workup | The costs of adding venous sampling to complete workup did not improve outcomes and increased cost |
| Adrenal venous sampling | Lubitz, et al., 2015 (196) | Decision tree model | CT/MR in resistant hypertension | CT/MR plus venous sampling was the most cost-effective screening approach |
| Musculoskeletal | ||||
| Percutaneous kyphoplasty | Itagaki, et al., 2012 (58) | Surgery | Retrospective | Reduced cost and length of stay versus surgery |
| Sinopulmonary | ||||
| Thermal ablations | Kwan, et al., 2014 (149) | Lobar resection NSCLC | Retrospective cohort | Costs were significantly less for thermal ablation due to outpatient setting |
| Lymphatic | ||||
| Lymphangiography | Pandharipande, et al., 2008 (93) | Sentinel biopsy staging in breast cancer | Markov modelling | The addition of lymphangiography best increased quality adjusted life expectancy per medical dollar spent |
| Gastrointestinal | ||||
| Gastroduodenal stenting | Jeurmink, et al., 2010 (97) | Gastrojejunostomy | Randomized control trial | Stenting was cheaper than gastrojejunostomy |
| PRG | Myssiorek, et al., 1998 (197) | PEG | Retrospective | PEG was over 500% more expensive than PRG |
| PRG | Barkmeier, et al., 1998 (198) | PEG and SEG | Retrospective | PEG < PRG < SEG. PEG and PRG equivalent for GJ and less than SEGJ |
| Renal | ||||
| Hemodialysis access maintenance | Trivedi, et al., 2020 (199) | Nephrologist and surgeon placement | Longitudinal cohort study | Nephrologists and Surgeons were 59% (P < 0.001) and 57% (P < 001) more expensive than IR |
| Renal denervation | Tilden, et al., 2014 (159) | Antihypertensives | Meta-analysis | Increased quality of life years, but at greater cost per year |
| Renal denervation | Geisler, et al., 2012 (158) | Antihypertensives | Markov model (Simplicity HTN-2 trial) | Cost savings accumulate for each quality-of-life year gains from reduced CV events |
| Reproductive | ||||
| Varicocele sclerotherapy | Abdulmaaboud, et al., 1998 (166) | Open and laparoscopic varicocelectomy | Retrospective | Sclerotherapy was significantly cheaper than open and laparoscopic surgery |
| Varicocele sclerotherapy | Johnsen, et al., 1996 (172) | Surgical varicocelectomy | Retrospective | Anterograde sclerotherapy is cheaper than all surgical options |
| Uterine fibroid embolization | Cain-Nielsen, et al., 2014 (200) | MR-focused ultrasound and myomectomy | Markov modelling | All three treatments offered similar QALY benefits, but UFE was most cost effective |
| Uterine fibroid embolization | Volkers, et al., 2008 (201) | Hysterectomy | Retrospective (EMMY Trial) | UFE had significantly lower mean total costs and saved patient costs with reduced work absences |
All statistically significant findings in each study are addressed. Case studies are excluded.