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A cost-minimization analysis of the angio-seal vascular closure device following percutaneous coronary intervention
Frederic S Resnic1, Nipun Arora, Michael Matheny
1Cardiovascular Division, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. fresnic@partners.org
Insights
Routine use of the Angio-Seal vascular closure device after percutaneous coronary intervention (PCI) is cost-effective. This approach offers significant cost savings compared to mechanical compression for femoral vascular access management.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) frequently requires vascular access management.
- The Angio-Seal device offers benefits in hemostasis time, patient comfort, and preference post-PCI.
- Health economic implications of routine Angio-Seal use post-PCI remain underexplored.
Purpose of the Study:
- To conduct a cost-minimization analysis comparing routine Angio-Seal use versus mechanical compression after PCI.
- To evaluate the economic impact of vascular access management strategies in PCI procedures.
Main Methods:
- A decision analytic model was employed for cost-minimization analysis.
- Vascular access complication probabilities were derived from pooled randomized trial data.
- Incremental hospital costs of complications were estimated using a matched case-control analysis of 3,943 PCI patients.
Main Results:
- Routine Angio-Seal use was associated with a cost saving of $44 per PCI procedure.
- Probabilistic sensitivity analysis confirmed an economic advantage for Angio-Seal in 74% of simulations.
- Cost savings are in addition to established benefits like improved patient comfort.
Conclusions:
- Routine use of the Angio-Seal device for femoral vascular access management post-PCI leads to net cost savings.
- Angio-Seal presents a cost-effective alternative to mechanical compression for vascular closure after PCI.
- The economic benefits complement the known clinical and patient-reported advantages of Angio-Seal.
Abstract:
The Angio-Seal vascular closure device has been shown to be safe and effective in decreasing the time to hemostasis after percutaneous coronary intervention (PCI). The health economic implications of routinely using Angio-Seal after PCI have not been explored. We performed a cost-minimization analysis comparing routine Angio-Seal use after PCI with mechanical compression using a decision analytic model. The relative probabilities of 7 vascular access complications were derived from pooled analysis of published randomized trials. The incremental hospital cost of each vascular complication was estimated by a matched case-control analysis of 3,943 patients who underwent PCI at our center from January 2002 and December 2004. Appropriate sensitivity and uncertainty analyses were performed. After accounting for differences in expected rates of specific complications between the 2 strategies and the incremental costs of each vascular event, the routine use of Angio-Seal was associated with a lower cost per PCI procedure of 44 dollars. Probabilistic sensitivity analysis of all model assumptions using second-order Monte Carlo simulation confirmed the economic advantage of Angio-Seal in 74% of model replications. In conclusion, after PCI, the routine use of Angio-Seal for femoral vascular access management was associated with net cost savings compared with mechanical compression. This cost savings was in addition to the previously demonstrated advantages of Angio-Seal in terms of patient comfort and preference.
