Determinants of high device cost in current percutaneous coronary interventions

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Interventional Cardiology

Background:

• Percutaneous coronary interventions (PCI) utilize substantial medical resources, particularly device costs.
• Identifying factors driving high PCI costs is crucial for resource management.
• Understanding lesion characteristics associated with elevated costs can inform clinical and economic strategies.

Purpose of the Study:

• To investigate the association between specific coronary artery lesion characteristics and medical device costs in PCI.
• To determine which lesion types are linked to the highest expenditures during PCI procedures.

Main Methods:

• Analysis of 593 coronary artery lesions from a PCI database (2015).
• Total PCI cost per lesion was calculated and categorized into highest (Q1) and low-intermediate (Q2-Q4) cost groups.
• Multivariate logistic regression was employed to identify significant predictors of high PCI costs.

Main Results:

• Lesion length (per 10mm increase), left main lesions, moderate-to-severe calcification, chronic total occlusion (CTO), and bifurcation lesions were significantly associated with the highest PCI costs.
• The highest cost group had a mean PCI cost of ¥1,032,943 ± 211,912, compared to ¥532,547 ± 112,127 in the low-intermediate cost group.
• Odds ratios indicated substantial cost increases for calcification (OR 16.43) and CTO (OR 5.83).

Conclusions:

• Coronary artery lesion characteristics such as CTO, long lesions, calcification, and bifurcation are significantly linked to higher PCI device costs.
• Complex non-CTO lesions (bifurcation, calcification) and CTO lesions incur greater PCI device costs than simpler lesions.
• These findings emphasize the economic impact of lesion complexity in PCI and suggest potential targets for cost-optimization.