Cost-Effectiveness of Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Intermediate-Risk Pulmonary Embolism: A PEERLESS Randomized Controlled Trial Post Hoc Analysis
13 affiliations
- 1Department of Cardiovascular Medicine, TriStar Centennial Medical Center, Nashville, Tennessee
- 2Allegheny Health Network, Erie, Pennsylvania
- 3Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
- 4Department of Radiology, Saint Louis University, Saint Louis, Missouri
- 5Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- 6Emplify Health, La Crosse, Wisconsin
- 7Department of Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio
- 8JB Medical Limited, London, United Kingdom
- 9Inari Medical Division of Stryker Corporation, Irvine, California
- 10Department of Medicine, Emory University Hospital, Atlanta, Georgia
- 11Division of Interventional Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
- 12Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 13Department of Cardiology, Bürgerspital Solothurn, Solothurner Spitäler AG (soH), Solothurn, Switzerland
Abstract
Background: This study evaluates the cost-effectiveness of large-bore mechanical thrombectomy (LBMT) compared with catheter-directed thrombolysis (CDT) for the treatment of intermediate-risk pulmonary embolism (PE).
Methods: A combined decision tree and Markov model was developed to estimate lifetime health care costs, quality-adjusted life years (QALY), and net monetary benefit from the perspective of the United States health care system. Event probabilities during PE management were derived from the PEERLESS randomized controlled trial. Resource utilization, costs, and long-term event probabilities were established from published literature. Scenario analyses and probabilistic sensitivity analyses were performed to characterize uncertainty.
Results: In the base case analysis, LBMT was cost-saving to CDT (ie, lower costs and higher QALY), with a net monetary benefit of $5850 for the willingness-to-pay threshold of $120,000/QALY for LBMT when compared to CDT. In the PE management phase, LBMT yielded a net $4755 cost-saving and 0.009 QALY gained per patient vs CDT, driven in large part by reduced intensive care unit utilization (–$6454), shorter hospital stay (–$2217), avoided thrombolytic costs (–$4068), and fewer 30-day readmissions (–$1134). The long-term care phase yielded a total of $32,012 additional costs per patient over the lifetime with no incremental difference in costs or QALY between groups. These additional costs were driven by venous thromboembolism–related death ($12,377), chronic thromboembolic pulmonary hypertension diagnosis and treatment ($8080), postacute anticoagulation management ($4512), and recurrent venous thromboembolism ($3289). LBMT remained cost-saving across scenarios evaluating CDT cost assumptions and device-specific chronic thromboembolic pulmonary hypertension rates. Probabilistic sensitivity analyses confirmed the robustness of these findings across multiple parameter ranges.
Conclusions: Intervention with LBMT in intermediate-risk PE patients in the United States is economically attractive when compared with CDT, resulting in reduced costs and marginally improved patient benefit.
Related
- Effects of mechanical thrombectomy combined with anticoagulation vs anticoagulation monotherapy for acute intermediate-high risk pulmonary embolism: study protocol for a randomized controlled trial (CAPE study, ChiCTR2500095253, https://www.medicalresearch.org.cn/clinicalResearch/researchInfo?id=c57630b7-51ec-4b24-83e1-85b9c0a835d6).
- Catastrophic High-Risk Pulmonary Embolism With Recurrent Cardiac Arrest Successfully Treated With Rescue Mechanical Thrombectomy After Systemic Thrombolysis
- Functional Benefit and Safety of Adjunctive Intra-Arterial Thrombolysis After Successful Endovascular Thrombectomy: An Updated and Cumulative Meta-Analysis of Randomized Trials
- Large-bore Mechanical Thrombectomy for Treatment of Intermediate-high Risk Pulmonary Embolism: A Single-center Australian Experience.
- Bridging Thrombolysis Versus Direct Endovascular Thrombectomy in Acute Ischemic Stroke Patients With ASPECTS ≤5: A Meta‐Analysis
BibTeX
@article{horr2026costeffectiveness,
title = {{Cost-Effectiveness of Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Intermediate-Risk Pulmonary Embolism: A PEERLESS Randomized Controlled Trial Post Hoc Analysis}},
author = {Samuel Horr and Orestis Pappas and Ripal T. Gandhi and Keith Pereira and Jay Giri and Sameer J. Khandhar and Ezana M. Azene and Joseph Campbell and Jonathan Belsey and Rick Wat and Jarrod Collins and Wissam A. Jaber and Carin F. Gonsalves and Stefan Stortecky},
journal = {Journal of the Society for Cardiovascular Angiography \& Interventions},
year = {2026},
month = aug,
doi = {10.1016/j.jscai.2026.105578},
url = {https://doi.org/10.1016/j.jscai.2026.105578},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cost-Effectiveness of Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Intermediate-Risk Pulmonary Embolism: A PEERLESS Randomized Controlled Trial Post Hoc Analysis
AU - Samuel Horr
AU - Orestis Pappas
AU - Ripal T. Gandhi
AU - Keith Pereira
AU - Jay Giri
AU - Sameer J. Khandhar
AU - Ezana M. Azene
AU - Joseph Campbell
AU - Jonathan Belsey
AU - Rick Wat
AU - Jarrod Collins
AU - Wissam A. Jaber
AU - Carin F. Gonsalves
AU - Stefan Stortecky
PY - 2026
DA - 2026/08/25
JO - Journal of the Society for Cardiovascular Angiography & Interventions
DO - 10.1016/j.jscai.2026.105578
UR - https://doi.org/10.1016/j.jscai.2026.105578
AB - Background: This study evaluates the cost-effectiveness of large-bore mechanical thrombectomy (LBMT) compared with catheter-directed thrombolysis (CDT) for the treatment of intermediate-risk pulmonary embolism (PE). Methods: A combined decision tree and Markov model was developed to estimate lifetime health care costs, quality-adjusted life years (QALY), and net monetary benefit from the perspective of the United States health care system. Event probabilities during PE management were derived from the PEERLESS randomized controlled trial. Resource utilization, costs, and long-term event probabilities were established from published literature. Scenario analyses and probabilistic sensitivity analyses were performed to characterize uncertainty. Results: In the base case analysis, LBMT was cost-saving to CDT (ie, lower costs and higher QALY), with a net monetary benefit of $5850 for the willingness-to-pay threshold of $120,000/QALY for LBMT when compared to CDT. In the PE management phase, LBMT yielded a net $4755 cost-saving and 0.009 QALY gained per patient vs CDT, driven in large part by reduced intensive care unit utilization (–$6454), shorter hospital stay (–$2217), avoided thrombolytic costs (–$4068), and fewer 30-day readmissions (–$1134). The long-term care phase yielded a total of $32,012 additional costs per patient over the lifetime with no incremental difference in costs or QALY between groups. These additional costs were driven by venous thromboembolism–related death ($12,377), chronic thromboembolic pulmonary hypertension diagnosis and treatment ($8080), postacute anticoagulation management ($4512), and recurrent venous thromboembolism ($3289). LBMT remained cost-saving across scenarios evaluating CDT cost assumptions and device-specific chronic thromboembolic pulmonary hypertension rates. Probabilistic sensitivity analyses confirmed the robustness of these findings across multiple parameter ranges. Conclusions: Intervention with LBMT in intermediate-risk PE patients in the United States is economically attractive when compared with CDT, resulting in reduced costs and marginally improved patient benefit.
SN - 2772-9303
ER -