Operative Outcome And Hospital Cost

Ferraris, Victor A.; Ferraris, Suellen P.; Singh, Amandeep

doi:10.1016/s0022-5223(98)70324-1

Cited by 79 publications

(50 citation statements)

References 18 publications

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“…The charges we used matched the procedure costs used in the Patterson and Eisner econometric model, which was found to be robust by sensitivity analysis to variable test fees (9). Our procedure costs are realistic and compare well with published values (33)(34)(35)(36), reflecting actual local charges and reimbursement rates in our geographic area, which are typically lower in upstate New York compared with most other parts of the country. Procedure charges were also confirmed by review of bills brought into the clinic by patients interviewed in the follow-up process.…”

Section: Limitationssupporting

confidence: 70%

Impact of Myocardial Perfusion Imaging with PET and 82Rb on Downstream Invasive Procedure Utilization, Costs, and Outcomes in Coronary Disease Management

Merhige¹,

Breen²,

Shelton³

et al. 2007

Journal of Nuclear Medicine

119

103

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We hypothesized that PET myocardial perfusion imaging with 82 Rb (PET MPI), would reduce downstream utilization of diagnostic arteriography, compared with SPECT, in patients matched for pretest likelihood of coronary disease (pCAD). PET MPI is more accurate for assessment of impaired coronary flow reserve compared with SPECT MPI, potentially reducing the demand for subsequent arteriography, percutaneous transcoronary intervention, and coronary artery bypass grafting (CABG), with attendant cost savings, while avoiding a negative impact on coronary events. Methods: The frequency of diagnostic arteriography, revascularization, costs, and 1-y clinical outcomes in 2,159 patients studied with PET MPI was compared with 2 control groups studied with SPECT MPI matched to the PET group by pCAD: an internal control group of 102 patients and an external SPECT control group of 5,826 patients. CAD management costs were approximated with realistic global fee estimates. Results: Arteriography rates were 0.34 and 0.31 for the external and internal control SPECT groups and 0.13 for the patients studied with PET (P , 0.0001). pCAD averaged 0.39 in patients studied with PET MPI, and in the external SPECT control group, and 0.37 in the internal SPECT controls. Revascularization rates were 0.13 and 0.11 for external and internal SPECT patients and 0.06 for the PET group (P , 0.0001; P , 0.01), with a cost savings of 30% noted for PET patients, with no significant difference in cardiac death or myocardial infaction at 1-y follow-up. Conclusion: PET MPI in patients with intermediate pCAD results in a .50% reduction in invasive coronary arteriography and CABG, a 30% cost savings, and excellent clinical outcomes at 1 y compared with SPECT.

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Section: Limitationssupporting

confidence: 70%

Impact of Myocardial Perfusion Imaging with PET and 82Rb on Downstream Invasive Procedure Utilization, Costs, and Outcomes in Coronary Disease Management

Merhige¹,

Breen²,

Shelton³

et al. 2007

Journal of Nuclear Medicine

119

103

View full text Add to dashboard Cite

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“…Morbidity and complications after surgery prolong hospital stay and are associated with significantly increased cost in hospital care [7,[10][11][12][13][14][15].…”

mentioning

confidence: 99%

Determinants of resource utilization and outcomes in laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of 14,251 patients

et al. 2011

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“…Information regarding costs was obtained primarily from the literature, including diagnostic related groups, and Medicare payments for current procedural terminology codes (Table 3). [17][18][19][20][21] The cost of the CTA was obtained from a study evaluating the cost-effectiveness of CTA in assessing patients with chest pain in the emergency department. 17 Given that CTA cost may differ given different protocols and indications for the imaging, it was subject to sensitivity analysis.…”

Section: Cost Informationmentioning

confidence: 99%

Cost-Effectiveness of Computed Tomographic Angiography Before Reoperative Coronary Artery Bypass Grafting

Gada

Desai

Marwick

2012

Circ: Cardiovascular Quality and Outcomes

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Background-The risks of repeat thoracotomy can be reduced if thoracic multidetector computed tomographic angiography (CTA) is used to guide preventive surgical strategies (PSS: peripheral cardiopulmonary bypass, circulatory arrest, and nonmedian sternotomy). We sought to define the cost-effectiveness of CTA using a Markov model. Methods and Results-We studied outcomes and costs of CTA and non-CTA strategies in a modeled cohort of 10 000 patients undergoing redo coronary artery bypass grafting. Rates of PSS implementation were anticipated to follow identification of risk by CTA. Transitions, costs, and utilities were informed by our experience and the literature. Sensitivity analyses included testing a range of costs of CTA and PSS on model outcome. In the reference case, cost and quality-adjusted life years accrued with the use of CTA ($74 869, 4.63 quality-adjusted life-years) were slightly higher than nonuse ($73 471, 4.59 quality-adjusted life-years), yielding an incremental cost-effectiveness ratio of $34 950/quality-adjusted life-years. Cost of PSS (equipment and operating time) was the most significant determinant of incremental cost-effectiveness ratio.In the reference case (cost of CTA ≈$300), identification and avoidance of potential procedural difficulties with CTA rendered it cost-effective if the cost of PSS was <$12 000. Across a range of CTA costs, incremental cost-effectiveness ratio was not materially influenced by outcomes across a broad range of imputed values. Conclusions-The cost of CTA appears justified in the setting of isolated reoperative coronary artery bypass grafting, because it aids in appropriate selection of PSS. The cost-effectiveness of this imaging seems more influenced by the costs of subsequent PSS than by the cost of CTA. (Circ Cardiovasc Qual Outcomes. 2012;5:705-710.)

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Operative Outcome And Hospital Cost

Cited by 79 publications

References 18 publications

Impact of Myocardial Perfusion Imaging with PET and 82Rb on Downstream Invasive Procedure Utilization, Costs, and Outcomes in Coronary Disease Management

Impact of Myocardial Perfusion Imaging with PET and 82Rb on Downstream Invasive Procedure Utilization, Costs, and Outcomes in Coronary Disease Management

Determinants of resource utilization and outcomes in laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of 14,251 patients

Cost-Effectiveness of Computed Tomographic Angiography Before Reoperative Coronary Artery Bypass Grafting

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