Pulmonary embolism (PE) is a common form of venous thromboembolism (VTE) and is the third most common cause of cardiovascular death.1 In the United States, PE accounts for approximately 300,000 annual deaths.1 Annual hospital expenditure on PE was estimated to be between $884,814 to $1866,489.2 Nationally, annual incident VTE events cost the United States an estimated $7–10 billion annually for 375,000 to 425,000 new diagnoses.3

Most literature relating to cost-analysis in VTE focuses on cost of acute PE managed in the postoperative setting or in patients managed primarily with anticoagulation. Estimates of hospital costs for acute PE vary widely based on the study and setting. An Australian study found that patients with VTE had greater radiology and total hospitalization costs compared to those without VTE.4

Total hospital charges for pulmonary embolism increased from $25,293 in 1998 to $43,740 in 2005.5 Patients with recent hospitalization for major operations who develop VTE have a 1.5 times greater cost than those who do not develop VTE, with an adjusted mean predicted costs of $55,956 compared with $32,718.6 Estimates of per-patient cost vary, with a mean annual per-patient expenditure of $37,800 for the VTE patients compared to $19,800 for non VTE patients (a difference of $18,000 per person-year).3

Anticoagulation is the primary treatment for pulmonary embolism. In recent years, advanced therapies including catheter directed thrombolysis (CDT), ultrasound-assisted thrombolysis (UAT), aspiration thrombectomy (utilizing syringe suction to aspirate thrombus compared with mechanical thrombectomy which utilizes rotating catheter heads to break up thrombus prior to aspiration), and mechanical thrombectomy (MT) have emerged in management of intermediate-high and high-risk PE.1 Studies have reported on outcomes using these devices, but there is a paucity of published data on the cost of these interventions. Aside from the medical benefit, the per-patient cost and system cost are crucial in determining best practices in a value-based care model.

The cost of the long-term consequences of PE are unclear. It is estimated that chronic thromboembolic pulmonary hypertension (CTEPH) costs an average monthly expenditure of $5500.3 The cost of chronic thromboembolic disease (CTED) is unknown.

There is a need for direct comparison of the costs and outcomes in patients admitted with PE and treated with standard medical therapy and advanced therapies. In this study, we compare the cost and outcomes in patients admitted with PE and treated using anticoagulation alone, CDT, and MT. We also evaluated the risk of CTEPH or CTED development based on intervention, which allows commentary on estimated risk of sequelae.