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In-hospital costs associated with new percutaneous coronary devices
R J Dick1, J J Popma, D W Muller
1Department of Internal Medicine (Cardiology Division), University of Michigan Medical Center, Ann Arbor 48109-0022.
Insights
Coronary stent placement and atherectomy significantly increase hospital costs and stay duration compared to angioplasty. Stenting led to a 102% cost increase, primarily due to longer hospitalizations for anticoagulation.
Area of Science:
- Cardiovascular Medicine
- Health Economics
Background:
- Coronary revascularization aims to improve blood flow to the heart muscle.
- Percutaneous coronary intervention (PCI) offers various techniques, including angioplasty, atherectomy, and stenting.
Purpose of the Study:
- To compare the economic impact of coronary angioplasty, atherectomy, and intracoronary stent placement.
- To analyze in-hospital costs and length of stay for different coronary revascularization methods.
Main Methods:
- Retrospective review of 149 patient accounts undergoing elective coronary revascularization.
- Comparison of in-hospital stay duration and total charges across three procedures: angioplasty, atherectomy, and stenting.
Main Results:
- Procedural success rates were over 90% and similar across all groups.
- Intracoronary stent placement resulted in significantly longer hospital stays (4.9 days) and higher charges ($12,574) compared to angioplasty (1.5 days, $6,220).
- Directional atherectomy also showed increased hospital stay and charges compared to angioplasty.
Conclusions:
- Coronary stenting and atherectomy lead to substantial increases in early hospital charges (102% and 34%, respectively) compared to angioplasty.
- Prolonged hospitalization, device costs, and anticoagulation time (for stents) are key drivers of increased costs.
Abstract:
To determine the relative economic impact of alternative methods of coronary revascularization, in-hospital patient accounts were reviewed in 149 patients undergoing elective coronary angioplasty (n = 50), coronary atherectomy (n = 72) or intracoronary stent placement (n = 27) over an 18-month period. Clinical and angiographic features were similar in the 3 groups, except that prior restenosis was seen more often in patients undergoing intracoronary stent placement. Procedural success, obtained in greater than 90% of patients, was independent of the treatment strategy. Total in-hospital stay was significantly longer in patients undergoing intracoronary stent placement than in patients undergoing coronary angioplasty and directional atherectomy (4.9 +/- 2.4 days vs 1.5 +/- 1.3 and 2.2 +/- 3.9 days, respectively; p less than 0.0001). Furthermore, the total in-hospital charges were significantly higher in patients undergoing intracoronary stent placement ($12,574 +/- $4,564 vs $6,220 +/- $5,716; p less than 0.001) and directional atherectomy ($8,329 +/- $8,588 vs $6,220 +/- $5,716; p less than 0.01) than in patients undergoing coronary angioplasty, reflecting overall differences in room costs, laboratory fees and pharmacy fees. The longer in-hospital stay in the intracoronary stent group was primarily attributed to the time required for anticoagulation with coumadin. It is concluded that a 102 and 34% increase in early hospital charges resulted with stenting or directional atherectomy, respectively, compared with coronary angioplasty. These increased in-hospital charges were chiefly due to the prolonged hospitalization time, device cost, laboratory fees and, in patients with intracoronary stents, the prolonged time needed to achieve systemic anticoagulation.