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Impact of policy alterations on elective percutaneous coronary interventions in Japan

Tetsuji Morishita1,2, Daisuke Takada1, Jung-Ho Shin1

  • 1Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Heart (British Cardiac Society)
|January 10, 2023
PubMed

Insights

A 2018 Japanese policy change requiring proof of ischemia significantly reduced monthly elective percutaneous coronary intervention (PCI) procedures for stable angina pectoris (SAP). Emergent PCI rates remained stable, indicating appropriate use of PCI.

Area of Science:

  • Cardiology
  • Health Policy
  • Health Economics

Background:

  • Clinical guidelines recommend documenting ischemia before elective percutaneous coronary intervention (PCI) for stable angina pectoris (SAP).
  • A 2018 Japanese reimbursement policy change mandated proof of ischemia for PCI procedures, aiming to ensure appropriate use.
  • The impact of this policy revision on PCI utilization for SAP in Japan was previously unclear.

Purpose of the Study:

  • To evaluate the effect of Japan's 2018 reimbursement policy revision on elective percutaneous coronary intervention (PCI) procedures for stable angina pectoris (SAP).
  • To assess whether the policy change influenced the appropriate utilization of PCI by examining trends in elective versus emergent procedures.

Main Methods:

  • Utilized administrative claims data from Japan's Diagnosis Procedure Combination database (April 2014–March 2020).
  • Employed interrupted time series analyses with a control group (emergent PCI) to assess the impact of the 2018 reimbursement revision.
  • Analyzed monthly trends in elective PCI procedures before and after the policy change.

Main Results:

  • A total of 773,240 PCI procedures were analyzed.
  • Following the 2018 reimbursement revision, a significant decrease in elective PCI procedures per month was observed (-106.3 procedures/month, p<0.01).
  • The number of emergent PCI procedures remained stable, suggesting the policy did not affect urgent interventions.

Conclusions:

  • The 2018 revision of the reimbursement policy in Japan led to a significant reduction in monthly elective percutaneous coronary intervention (PCI) procedures for stable angina pectoris (SAP).
  • This policy change appears to have successfully promoted more judicious use of PCI by requiring documented evidence of ischemia.
Abstract

Keywords:
angina pectorispercutaneous coronary intervention

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