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The economic burden of complications during percutaneous coronary intervention
  1. Kurt M Jacobson1,
  2. Kirsten Hall Long2,
  3. Erin K McMurtry2,
  4. James M Naessens2,
  5. Charanjit S Rihal3
  1. 1Division of Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Division of Health Care Policy & Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to:
 Charanjit S Rihal
 Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA;rihal{at}mayo.edu

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.

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Footnotes

  • Funding: Mayo Foundation for Medical Education and Research.

  • Competing interest: None.

  • Previous presentation: Presented as a poster at the International Society for Pharmacoeconomics and Outcomes Research 8th Annual European Congress; November 7, 2005; Florence, Italy. Additional oral presentation occurred at the Inaugural Conference of the American Society of Health Economists; June 6, 2006; Madison, Wisconsin, USA.

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