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Treatment charges for acute coronary syndrome: A retrospective analysis
Luke Frizzell1, Jonathan Deleon1, Sean Reilly1
1Texas A&M University College of Medicine, Temple, Texas, USA.
Insights
Coronary artery bypass grafting (CABG) has higher total costs than percutaneous coronary intervention (PCI) due to longer hospital stays, but lower daily charges. Reducing length of stay (LOS) is key for managing CABG costs and readmissions.
Area of Science:
- Cardiovascular Medicine
- Health Economics
Background:
- Acute coronary syndrome (ACS) treatment involves strategies like coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical management (MM).
- Previous analyses indicated superior outcomes with CABG over PCI and MM.
Purpose of the Study:
- To analyze cost variations in ACS treatment based on strategy (CABG vs. PCI), hospital length of stay (LOS), and readmission rates.
- To identify key drivers of total charges and daily expenses for different ACS treatment pathways.
Main Methods:
- A substudy utilizing electronic health records from 4267 ACS patients (2018-2022).
- Extraction of total reimbursements, LOS, and readmission data for CABG, PCI, and MM cohorts.
- Comparative cost analysis focusing on total charges, daily charges, LOS, and readmission impact.
Main Results:
- CABG patients incurred higher total charges than PCI patients (+$106,047), primarily driven by an 8.35-day longer LOS.
- Despite higher total costs, CABG patients had lower average daily charges than PCI patients (+$14,957).
- Readmissions increased total charges by an average of $22,765 ± $11,820, though daily charges remained lower due to extended LOS.
Conclusions:
- Higher total costs for CABG and readmissions underscore the need for strategies to reduce LOS.
- Optimizing LOS and minimizing charges associated with CABG and readmissions are crucial for cost-effective ACS management.
Background:
This study analyzes the costs associated with treatment strategies for acute coronary syndrome: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical management (MM).
Methods:
This is a substudy of a previous analysis showing improved outcomes with CABG compared to PCI and MM, now focusing on variation in charges based on the type of treatment, hospital length of stay (LOS), and the occurrence of hospital readmission. We extracted total reimbursements, LOS, and readmissions for acute coronary syndrome patients (4267) between 2018 and 2022 from the electronic health record.
Results:
Expenses related to total charges were higher for CABG patients than PCI patients (+$106,047); however, average daily charges were lower for CABG patients compared to PCI patients (+$14,957). LOS was a primary driver for total charges, as CABG patients stayed 8.35 ± 0.50 days longer than PCI patients on average. The average difference between the total charge amount for readmitted and nonreadmitted patients was $22,765 ± $11,820. Even though readmission increases total charges, the charge per day was still less in patients with readmission due to their longer LOS.
Conclusion:
The higher total charge amount and lower charge per day in CABG patients compared to PCI patients, as well as readmitted patients, highlights the importance of employing strategies to reduce LOS and minimize charges for CABG and readmissions.
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