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Cost Change of Elective Percutaneous Coronary Artery Intervention for Chronic Coronary Syndrome in Japan From 2010 to
Masahiko Fujihara1,2, Tomofumi Tsukizawa1, Yuko Yazu3
1Department of Cardiology, Kishiwada Tokushukai Hospital.
Insights
Reimbursement revisions significantly reduced medical fees for percutaneous coronary intervention (PCI) in chronic coronary syndrome (CCS) patients. However, these cost reductions did not impact patient survival or major adverse cardiovascular events (MACCE).
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Medical fees for chronic coronary syndrome (CCS) investigations and percutaneous coronary intervention (PCI) have been impacted by insurance reimbursement revisions.
- This retrospective study examines the financial and clinical outcomes associated with these changes.
Purpose of the Study:
- To investigate the impact of biennial revisions in insurance reimbursement costs on medical fees for PCI in CCS patients.
- To evaluate the effect of these fee changes on patient mortality and major adverse cerebral and cardiovascular events (MACCE).
Main Methods:
- Retrospective analysis of 1,483 patients undergoing elective PCI for CCS between April 2010 and September 2019.
- Primary outcomes: Changes in PCI procedure and hospitalization fees across five time periods.
- Secondary outcomes: Survival rates and freedom from MACCE.
Main Results:
- Significant decreases in PCI procedure fees (-25%) and hospitalization fees (-20%) were observed from 2010 to 2019.
- Treatment procedures evolved, with increased use of transradial access, drug-eluting stents, and imaging modalities.
- No significant differences in survival or MACCE rates were found between the study periods.
Conclusions:
- Revisions in reimbursement prices led to substantial reductions in PCI procedure and hospitalization fees for CCS.
- These financial changes did not adversely affect patient mortality or cardiovascular event rates.
Background:
Because of revisions to insurance reimbursement costs, medical fees have changed for investigations and percutaneous coronary intervention (PCI) treatment of chronic coronary syndrome (CCS). In this retrospective study, we investigated these changes and their effects on mortality and cardiovascular events.
Methods And Results:
We included 1,483 patients who underwent elective PCI for CCS between April 2010 and September 2019. The primary outcomes were changes in PCI procedure fees and all included hospitalization fees due to the biennial revisions of reimbursement costs across 5 time periods (~2 years each). Secondary outcomes were rates of survival and freedom from major adverse cerebral and cardiovascular events (MACCE) in each time period. Patient characteristics were generally unchanged over the study period; however, treatment procedures changed significantly, with changes in the approach site (from transfemoral to transradial access; P<0.0001) and final device (from bare-metal stents to drug-eluting stents; P<0.0001), and an increase in the use of imaging modalities (P<0.0001). Medical fee parameters (primary outcomes) decreased significantly from 2010 to 2019 (P<0.001): PCI procedure fees decreased by 25%, whereas all included hospitalization fees decreased by 20%. There were no significant differences in survival or freedom-from-MACCE rates between periods.
Conclusions:
Because of revisions to reimbursement prices, there were rapid and significant decreases in PCI procedure and hospitalization fees for CCS. These changes had no effect on mortality or cardiovascular events.
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