Determinants of high device cost in current percutaneous coronary interventions

Percutaneous coronary interventions (PCI), especially medical devices, consume large amounts of medical resources. It is important to know which type of lesions requires high device costs among current PCI. The purpose of this study was to investigate the association between lesion characteristics and medical device costs in current PCI.

We identified 593 coronary artery lesions in our PCI database between January 1, 2015 and December 31, 2015. The total PCI cost was calculated for each lesion. The highest quartile (Q1) of total PCI costs was defined as the highest cost group, whereas the other quartiles (Q2, Q3, Q4) were defined as the low-intermediate cost group.

The mean PCI cost in the highest cost and low-intermediate cost groups was ¥1,032,943 ± 211,912 and ¥532,547 ± 112,127, respectively. In a multivariate logistic regression analysis, lesion length (10 mm increase: OR 2.93, 95% CI 2.25-3.82, P < 0.001), left main lesion (OR 2.96, 95% CI 1.02-8.60, P = 0.046), moderate to severe calcification (OR 16.43, 95% CI 7.97-33.88, P < 0.001), chronic total occlusion (CTO) (OR 5.83, 95% CI 2.07-16.39, P = 0.001), and bifurcation (OR 2.01, 95% CI 1.08-3.75, P = 0.027) were significantly associated with the highest cost group.

Lesion characteristics including CTO, diffuse long lesion, calcification, and bifurcation were significantly associated with the highest device cost. Non-CTO complex lesions including bifurcation and calcification as well as CTO lesions require higher PCI device costs than non-complex lesions.