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[Hemodynamic and coronary angiographic performance at a center with medium-low activity: organization model, activity
G Vergara1, R Accardi, F Imperadore
1Azienda Provinciale per i Servizi Sanitari del Trentino, Unità Operativa di Cardiologia, Ospedale S. Maria del Carmine, Rovereto, TN. vergara@rov.aziendasanitaria.trentino.it
Insights
Coronary angiography is cost-effective in low-volume centers. This study demonstrates efficient laboratory performance and low complication rates for this cardiac procedure, even with reduced caseloads.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Medical Technology Assessment
Context:
- Evaluating the financial viability of specialized medical procedures in healthcare settings with limited patient volume.
- Assessing the operational efficiency of multipurpose cardiac catheterization laboratories handling diverse procedures.
- Analyzing the impact of laboratory location on the cost-effectiveness of diagnostic cardiac interventions.
Purpose:
- To determine the cost-effectiveness of performing coronary angiography in a low-volume center.
- To evaluate the performance metrics of a cardiac catheterization laboratory, including utilization, appropriateness, and complication rates.
- To compare the costs of in-house coronary angiography versus a historical, more distant laboratory setting.
Summary:
- A 1-year analysis of a multipurpose cardiac catheterization laboratory revealed 342 coronary angiographies (46% of caseload).
- The study reported low complication rates (0.58% vascular, 0.29% myocardial infarction) and no repeat procedures due to quality issues.
- Mean cost per coronary angiography was €265 in-house, versus €359 historically, indicating significant savings in a low-volume center.
Impact:
- Coronary angiography can be performed effectively and efficiently in low-volume centers, challenging assumptions about procedural economics.
- The findings support the feasibility of maintaining high standards of care and cost-efficiency in smaller or specialized cardiac facilities.
- This research provides valuable data for healthcare administrators and policymakers regarding the optimal placement and operation of cardiac catheterization services.
Background:
In order to evaluate the cost-effectiveness of coronary angiography performed in a low volume Center, we examined our 1-year activity.
Methods:
The organizational model of the multipurpose cardiac catheterization laboratory is described. In this type of facility both coronary angiographic and electrophysiological studies are performed. To evaluate the laboratory performance we examined the utilization level, the appropriateness of the studies, the complication rates and the number of studies that had to be repeated because of inadequate data or image quality. The costs were calculated for the in-house laboratory setting (the actual scenario) and for the 25 km distant laboratory setting (the historical scenario).
Results:
The laboratory caseload of coronary angiography was 342 studies, 46% of the overall laboratory activity; 175 patients (51%) underwent non-pharmacological therapy, 129 patients (38%) were treated with medical therapy; the percentage of patients with normal coronary arteries was 11%. Two patients (0.58%) had vascular complications, 1 patient (0.29%) developed an acute myocardial infarction 2 hours after coronary angiography without any evidence of angiographic modifications at the repeated study. In no patient the study had to be repeated because of inadequate data or image quality. The mean cost of a coronary angiography was Lit. 512,000 (265 Euro) for the actual scenario; it would have been Lit. 694,000 (359 Euro) for the historical scenario, with Lit. 182,000 (94 Euro) saved.
Conclusions:
These findings are consistent with the accepted criteria of good laboratory performance and cost-effectiveness. Thus coronary angiography can be performed effectively and efficiently in a low volume Center.