Article Text
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.
- GLM, generalised linear modelling
- ICD-9, international classification of diseases, ninth revision
- LOS, length of stay
- MACCE, major adverse cardiac and cerebrovascular events
- PCI, percutaneous coronary intervention
- TVR, target vessel revascularisation
- percutaneous coronary intervention
- complications
- costs
- resource utilisation
- GLM, generalised linear modelling
- ICD-9, international classification of diseases, ninth revision
- LOS, length of stay
- MACCE, major adverse cardiac and cerebrovascular events
- PCI, percutaneous coronary intervention
- TVR, target vessel revascularisation
- percutaneous coronary intervention
- complications
- costs
- resource utilisation
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- GLM, generalised linear modelling
- ICD-9, international classification of diseases, ninth revision
- LOS, length of stay
- MACCE, major adverse cardiac and cerebrovascular events
- PCI, percutaneous coronary intervention
- TVR, target vessel revascularisation
- percutaneous coronary intervention
- complications
- costs
- resource utilisation
- GLM, generalised linear modelling
- ICD-9, international classification of diseases, ninth revision
- LOS, length of stay
- MACCE, major adverse cardiac and cerebrovascular events
- PCI, percutaneous coronary intervention
- TVR, target vessel revascularisation
- percutaneous coronary intervention
- complications
- costs
- resource utilisation
Footnotes
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Funding: Mayo Foundation for Medical Education and Research.
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Competing interest: None.
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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.