The economic burden of complications during percutaneous coronary intervention

Abstract

Background: Technological advances have enabled percutaneous coronary intervention (PCI) to be applied with expanding indications. However, escalating costs are of concern. This study assessed the incremental medical costs of major in-hospital procedural complications incurred by patients undergoing PCI. Methods: We considered all patients undergoing elective, urgent, or emergent PCI at Mayo Clinic Rochester between 3/1/1998-3/31/2003 in analyses. Clinical, angiographic, and outcome data were derived from the Mayo Clinic PCI Registry. In-hospital PCI complications included major adverse cardiac and cerebrovascular events (MACCE) and bleeding of clinical significance. Administrative data were used to estimate total costs in standardised, year 2004, constant-US dollars. We used generalised linear modeling to estimate costs associated with complications adjusting for baseline and procedural characteristics. Results: 1071 (13.2%) of patients experienced complications during hospitalisation. Patients experiencing complications were older, more likely to present with emergent PCI, recent or prior myocardial infarction, multi-vessel disease, and comorbid conditions than patients who did not experience these events. Unadjusted total costs were, on average, $27 865¡$39 424 for complicated patient episodes compared to $12 279¡$6796 for episodes that were complication free (p,0.0001). Adjusted mean costs were $6984 higher for complicated PCIs compared with uncomplicated PCI episodes (95% CI of cost difference: $5801, $8168). Incremental costs associated with isolated bleeding events, MACCE, or for both bleeding and MACCE events were $5883, $5086, and $15 437, respectively (p,0.0001). Conclusions: This high-volume study highlights the significant economic burden associated with procedural complications. Resources and systems approaches to minimising clinical and economic complications in PCI are warranted.

Cost‐Effectiveness of Cytochrome P450 2C19 Genotype Screening for Selection of Antiplatelet Therapy with Clopidogrel or Prasugrel

“…All event costs, including direct medical costs of hospitalization due to PCI, costs of drug therapy, and costs associated with events incorporated into the model were derived from publically available sources and are shown in Table . Costs for genotyping were obtained by averaging reported costs from a direct‐to‐consumer Web site for CYP2C19 testing (cost includes testing for CYP2C19 *1 , *2 , *3 , *4 , *5 , *6 , *7 , *8 , and *17 ) and costs derived from Current Procedural Terminology codes associated with molecular testing for the state of Maryland .…”

Predictors of Complications Following Sheath Removal With Percutaneous Coronary Intervention

“…Percutaneous coronary intervention complications have been linked to increased consumption of healthcare resources, delays in hospital discharge, and patient dissatisfaction. It was reported that PCI bleeding complications cost an additional US $13,092 and added 4.4 days to a patient's hospitalization, 2 and vascular complications cost an additional US $4,830 and 2.1 hospital days. 3 The incidence of vascular complications ranges from 5.4% to 37%.…”

SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Association of interventional cardiology–Association canadienne de cardiologie d'intervention)*

“…Cost reduction efforts may target CCL operating costs and/or costs of care outside the CCL. For example, lower stent prices will reduce expenses in the CCL, whereas drug-eluting stents may reduce costs outside the CCL; reducing procedural complications will reduce both in-lab and out-of-lab costs [67,68]. Specific recommendations include the following:…”