Clinical correlates of the initial and long-term cost of coronary bypass surgery and coronary angioplasty

Hlatky, Mark A.; Boothroyd, Derek B.; Brooks, Maria M.; Winston, Carla A.; Rosen, Allan D.; Rogers, William J.; Reeder, Guy S.; Smith, Hugh C.; Ryan, Thomas J.; Pitt, Bertram; Whitlow, Patrick L.; Wiens, Robert D.; Mark, Daniel B.

doi:10.1016/s0002-8703(99)70128-6

Cited by 30 publications

(17 citation statements)

References 23 publications

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“…The contribution of comorbidities and severity of disease to total hospital costs is clear. The axiom that "sicker people consume more resources" is generally consistent within the results reported in this study, thus emphasizing the importance of understanding underlying patient characteristics as they relate to cost of care (Table II) [6,28,29]. While the sample selection term was nonsignificant in this analysis, selection bias requires one to make appropriate adjustments for differences between patient groups in order to obtain more meaningful comparisons.…”

Section: Discussionsupporting

confidence: 78%

A comparison of total hospital costs for percutaneous coronary intervention patients receiving abciximab versus tirofiban

McCollam

Lage

Bala³

2001

Cathet Cardio Intervent

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The purpose of this study was to examine the total hospital costs associated with the receipt of abciximab versus tirofiban for percutaneous coronary intervention (PCI) patients. Hospital billing data for patients with a primary procedure of PCI was examined for the period of July 1998 to June 1999 from HCIA-Sach's Clinical Pathways Database. Data were analyzed for all patient discharges whose records indicated use of abciximab or tirofiban with a PCI. Results are reported for 3,967 patients. Multivariate analysis was used to control for a wide range of factors (GP IIb/IIIa selection, patient demographics, stent use, insurance type, health conditions, admission information, and hospital characteristics) that may influence the cost of hospitalization. A two-stage sample selection model was used to estimate total costs. The first stage of the analysis utilizes a probit regression to determine the factors associated with the likelihood of receiving abciximab versus tirofiban. The second stage of the analysis examines the factors associated with total hospital costs, while controlling for unobserved factors that may be correlated with the patient's likelihood of receiving abciximab. The mean unadjusted cost per hospitalization, including drug costs, was $10,762 (abciximab $10,813 and tirofiban $10,567). After controlling for high-risk indications and selection bias with the two-stage sample selection model, results indicate there was no significant difference in costs associated with the receipt of abciximab versus tirofiban. However, the results also indicate that the two-stage sample selection model may not be needed (lambda was not statistically significant) hence, the cost equation was reestimated using ordinary least-squares methodology (OLS). In the OLS analysis, receipt of abciximab versus tirofiban was associated with a significant reduction in costs ($470 reduction; P = 0.05). This study uses real-world data to examine the total hospital costs for PCI patients who receive abciximab versus tirofiban. Results of the two-stage sample selection model indicate there is no difference in total hospital costs (including drug costs) between abciximab- and tirofiban-treated patients. If the results of the OLS model are considered, a slight decrease in total hospital costs is observed in abciximab recipients. Cost-containment strategies that focus on component costs may not lead to intended overall cost savings.

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Section: Discussionsupporting

confidence: 78%

A comparison of total hospital costs for percutaneous coronary intervention patients receiving abciximab versus tirofiban

McCollam

Lage

Bala³

2001

Cathet Cardio Intervent

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“…We used a nonward cost proportion of 55% for PCI [20] and a cost proportion of 30% incurred in theater in cardiac surgery for CABG [21]. Non-Q-wave MIs occurring after initial hospitalization discharge were assumed to cost 31% of a Q-wave MI [22]. The costs of MIs during the initial hospitalization were covered by ward, angiography, PCI, and CABG costs.…”

Section: Unit Costsmentioning

confidence: 99%

Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of non–ST-segment elevation acute coronary syndromes

et al. 2011

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“…Finally, the treatment (e.g. PTCA) had to be completed without any complications (Hlatky et al, 1999).…”

Section: Case Description and Data Collectionmentioning

confidence: 99%

Variations in hospitalisation costs for acute myocardial infarction – a comparison across Europe

Tiemann¹

2008

Health Econ.

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SUMMARYThe aim of this study was to determine whether between-country variations in hospital costs are larger than withincountry variations and, furthermore, to explore reasons for this variability. For this purpose, we chose the primary treatment of patients with acute myocardial infarction (AMI) as an episode of care. We obtained hospitalisation costs and reimbursement rates from 45 hospitals in nine different EU member states (i.e. Denmark, England, France, Germany, Hungary, Italy, Netherlands, Poland, and Spain) for the year 2005. To further analyse the variations in hospital costs, we employed a hierarchical random effects model based on treatment and hospital characteristics and using purchasing power parities (PPPs) as a proxy for country-specific price levels. The betweencountry standard error was estimated at h2473; whereas the within-country standard error was estimated at h1242: Our regression analysis showed that percutaneous coronary intervention was associated with significantly increased hospitals costs compared to other treatment strategies. We were able to distinguish between three groups of countries with different cost levels based on the number of hospitals that were able to provide these services (i.e. percutaneous transluminal coronary angioplasty (PTCA) with intracoronary stenting). Excluding Hungary, Poland, and Spain, where none of the participating hospitals were able to provide these procedures, the betweencountry standard error decreased to h1632; whereas the within-country standard error increased to h1416: Finally, we observed exogenous price-level effects between countries and within countries for hospitals located in urban areas.

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Clinical correlates of the initial and long-term cost of coronary bypass surgery and coronary angioplasty

Cited by 30 publications

References 23 publications

A comparison of total hospital costs for percutaneous coronary intervention patients receiving abciximab versus tirofiban

A comparison of total hospital costs for percutaneous coronary intervention patients receiving abciximab versus tirofiban

Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of non–ST-segment elevation acute coronary syndromes

Variations in hospitalisation costs for acute myocardial infarction – a comparison across Europe

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