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Cost advantages of an ad hoc angioplasty strategy
C Adele1, P T Vaitkus, S K Wells
1Department of Medicine, University of Vermont College of Medicine, Burlington, USA.
Insights
An ad hoc strategy of percutaneous transluminal coronary angioplasty (PTCA) showed no consistent cost savings. Cost advantages were observed with stenting, but complications negated financial benefits.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- The assumption that same-sitting diagnostic catheterization and percutaneous transluminal coronary angioplasty (PTCA) (ad hoc) reduces costs by lowering hospital stay (LOS) is common but lacks contemporary data.
- This study examines the cost-effectiveness of ad hoc versus staged PTCA in a current patient cohort.
Purpose of the Study:
- To determine the cost advantage of an ad hoc PTCA strategy compared to a staged PTCA approach.
- To analyze costs across different clinical strata: stable angina, unstable angina, and post-myocardial infarction (MI).
Main Methods:
- A cost analysis was conducted on 395 patients undergoing PTCA over six months.
- Standard cost-accounting methods were employed.
- Costs were stratified by indication for PTCA (stable angina, unstable angina, post-MI).
Main Results:
- No significant cost advantage for the ad hoc strategy was found across all patient strata.
- A trend towards ad hoc approach was noted in stable angina patients.
- Patients receiving stents demonstrated a significant cost advantage with the ad hoc strategy.
- Complication rates, though not statistically significant, trended higher with ad hoc PTCA, negating potential cost and LOS benefits.
Conclusions:
- Consistent cost savings with an ad hoc PTCA strategy were not demonstrated.
- Cost advantages may be realized in low-risk settings (stable angina) or with devices reducing complications (stenting).
- Even minor increases in complication rates with ad hoc PTCA can eliminate financial benefits.
Objectives:
We sought to determine the cost advantage of a strategy of same-sitting diagnostic catheterization and percutaneous transluminal coronary angioplasty (PTCA) (ad hoc) in comparison with staged PTCA.
Background:
It is widely assumed that an ad hoc strategy lowers costs by reducing the length of hospital stay (LOS). However, this assumption has not been examined in a contemporary data set.
Methods:
We studied 395 patients undergoing PTCA during 6 consecutive months. Cost analysis was performed using standard cost-accounting methods and a mature cost-accounting system. Costs were examined within three clinical strata based on the indication for PTCA (stable angina, unstable angina and after myocardial infarction [MI]).
Results:
For the entire patient cohort, there was no significant cost advantage of an ad hoc approach within any of the strata, although there was a nonsignificant trend toward an ad hoc approach in patients with stable angina. For patients treated with conventional balloon PTCA alone, the lack of a significant difference between ad hoc and staged strategies persisted. For patients who received stents, there was a significant cost advantage of an ad hoc approach in all three clinical strata. An important cost driver was the occurrence of complications. Differences in the rates of complications did not reach statistical significance between ad hoc and staged strategies, but even a small trend toward greater complications in patients who had the ad hoc strategy negated cost and LOS advantages. Our study had the power to detect significant cost differences of $1,300 for patients with stable angina, $2,100 for patients with unstable angina and $2,500 for post-MI patients. It is possible that we failed to detect smaller cost advantages as significant.
Conclusions:
A cost savings with an ad hoc strategy of PTCA could not be consistently demonstrated. The cost advantage of an ad hoc approach may be most readily realized in clinical settings where the intrinsic risks are low (e.g., stable angina) or in which the device used carries a reduced risk of complications (e.g., stenting), because even a small increase in the complication rate will negate any financial advantage of an ad hoc approach.