The Economic Burden of Experiencing a Major Complication during Percutaneous Coronary Intervention
- Presenter:
Chair: Melayne McInnes; Discussant: TBA Tue June 6, 2006 13:45-15:15 Room 121
Objectives: Technological advances (including coronary stents and new anti-thrombotic regimens) have significantly reduced rates of ischemic complications and enabled percutaneous coronary intervention (PCI) to be applied to expanding indications. However, escalating costs are of concern to patients, providers and payers. This study assessed the incremental medical costs of treating major in-hospital procedural complications incurred by patients undergoing PCI.
Methods: We considered all patients undergoing elective, urgent, or emergent PCI at Mayo Clinic Rochester between 3/1/1998-3/31/2003 in analyses. Exclusions included elective, staged procedures during hospitalization (atypical events) and episodes for patients who denied research authorization. Clinical, angiographic, and outcome data were derived from the Mayo Clinic PCI Registry. In-hospital PCI complications included major adverse cardiac and cerebrovascular events (MACCE) (defined as death, myocardial infarction [MI], emergent coronary bypass surgery, repeat PCI, or stroke) and bleeding of clinical significance. Administrative data was used to estimate total costs (hospital and physician) in standardized, year 2004 constant-dollars. We used generalized linear modeling (inverse Gaussian with log link) to estimate the incremental costs associated with complications adjusting for demographic, clinical, angiographic, and procedural characteristics.
Results: 8,109 eligible PCIs episodes (7,027 treated patients) occurred during the study duration. In 1,071 (13.2%) of these episodes, patients experienced at least one of the selected complications during hospitalization. Both MACCE and bleed events occurred in 147 (13.7%) of these complicated procedural cases. Patients experiencing complications were older, more likely to present with emergent PCI, recent or prior MI, multi-vessel disease, B2/C type lesions, and comorbid conditions than patients who did not experience these events. Unadjusted total costs were, on average, $27,865 + $39,424 for patients who experienced any complication compared to $12,279 + $6,796 for those who were free of complications (p<0.001). A nearly 5-fold increase in inpatient costs was observed among patients with and without MACCE and major bleeding complications ($55,230 vs. $12,279, respectively; p<0.001). Adjusted mean total cost were $7,000 higher for patients experiencing complications compared with patients who were complication free (95% CI of cost difference: $5,854, $8,145). Incremental costs associated with only bleeding events, only MACCE, or for patients experiencing bleeding and MACCE events were $5,813, $5,151, and $15,699, respectively (p<0.001).
Conclusions: This observational study highlights the significant economic burden associated with in-hospital procedural complications. Bleeding complications alone contribute significantly to inpatient cost of care. Interventions to reduce the risk of adverse events likely enhance financial as well as clinical performance.
