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Cost implications of intraprocedural thrombotic events during PCI
Stephanie Plent1, Weihong Fan1, Ajay Kirtane2
1The Medicines Company, Parsippany, New Jersey.
Insights
Intraprocedural thrombotic events (IPTE) during percutaneous coronary intervention for acute coronary syndromes significantly increase healthcare costs. Preventing IPTE may offer substantial cost savings and improve patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Health Economics
Background:
- Intraprocedural thrombotic events (IPTE) in patients undergoing percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndromes (NSTEACS) are linked to higher adverse cardiac event rates.
- The economic impact of IPTE in this patient population remains largely unquantified.
Purpose of the Study:
- To estimate the direct in-hospital and 30-day costs associated with IPTE in NSTEACS patients undergoing PCI.
- To determine the economic burden of IPTE in this high-risk group.
Main Methods:
- Analysis of hospital costs from the ACUITY Trial, comparing patients with and without IPTE.
- Utilized generalized linear models (GLMs) for adjusted cost comparisons.
- All costs were reported in 2012 US dollars.
Main Results:
- A total of 1,307 patients were analyzed, with IPTE occurring in 4.0% (52 patients).
- IPTE was associated with significantly higher median in-hospital costs ($23,719 vs. $18,419) and 30-day costs ($23,719 vs. $19,556).
- Adjusted analyses revealed IPTE increased in-hospital costs by 19.5% (median $3,592) and 30-day costs by 18.9% (median $3,696).
Conclusions:
- Intraprocedural thrombotic events during PCI for NSTEACS lead to substantial increases in healthcare expenditures.
- Implementing strategies to prevent IPTE could result in significant cost offsets.
- Preventing IPTE may concurrently improve clinical outcomes and reduce economic burden.
Objectives:
We sought to estimate the direct costs (in-hospital and 30-day) associated with an intraprocedural thrombotic event (IPTE) among patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI).
Background:
Patients with IPTE have higher rates of in-hospital and 30-day major adverse cardiac events than patients without IPTE. The extent to which IPTE also add to medical costs is unknown.
Methods:
Hospital costs for patients in the ACUITY Trial were compared between patients with and without IPTE. Adjusted comparisons were performed using generalized linear models (GLMs). All costs are reported in 2012 US dollars.
Results:
A total of 1,307 patients with both core laboratory-based angiographic assessment and detailed economic data were included in the final study population. IPTE occurred in 52 patients (4.0%). Median in-hospital costs were higher in patients with IPTE than in those without IPTE ($23,719 vs. $18,419, P = 0.01). Thirty-day median costs were also higher for IPTE patients ($23,719 vs. $19,556, P = 0.05). After adjusting for baseline differences, IPTE was associated with 19.5% (95% CI: [2.8-38.8%], P = 0.02) and 18.9% (95% CI: [1.2-39.7%], P = 0.04) increases in in-hospital and 30-day costs, respectively. These relative differences represent median increases of $3,592 in initial hospital costs and $3,696 in 30-day costs.
Conclusions:
The occurrence of IPTE during the index PCI in patients with NSTEACS is associated with substantial increases in-hospital and 30-day costs. These findings suggest that strategies to prevent IPTE may be associated with important cost offsets as well as improved clinical outcomes.
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