1
|
Tamez H, Généreux P, Yeh RW, Amin AP, Fan W, White HD, Kirtane AJ, Stone GW, Gibson CM, Harrington RA, Bhatt DL, Pinto DS. Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention: Results from the CHAMPION PHOENIX ECONOMICS Study. Catheter Cardiovasc Interv 2018; 92:E348-E355. [PMID: 29726596 DOI: 10.1002/ccd.27638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/12/2018] [Accepted: 03/23/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite improvements in percutaneous coronary intervention (PCI), intraprocedural thrombotic events (IPTE) and bleeding complications occur and are prognostically important. These have not been included in prior economic studies. METHODS PHOENIX ECONOMICS was a substudy of the CHAMPION PHOENIX trial, evaluating cangrelor during PCI. Hospital bills were reviewed from 1,171 patients enrolled at 22 of 63 US sites. Costs were estimated using standard methods including resource-based accounting, hospital billing data, and the Medicare fee schedule. Bleeding and IPTE, defined as abrupt vessel closure (transient or sustained), new/suspected thrombus, new clot on wire/catheter, no reflow, side-branch occlusion, procedural stent thrombosis or urgent need for CABG were identified. Costs were calculated according to whether a complication occurred and type of event. Multivariate analyses were used to estimate the incremental costs of IPTE and postprocedural events. RESULTS IPTE occurred in 4.3% and were associated with higher catheterization laboratory and overall index hospitalization costs by $2,734 (95%CI $1,117, $4,351; P = 0.001) and $6,354 (95% CI $4,122, $8,586; P < 0.001), respectively. IPTE were associated with MI (35.4% vs. 3.6%; P < 0.001), out-of-laboratory stent thrombosis (4.2% vs. 0.1%; 0 = 0.005), ischemia driven revascularization (12.5% vs. 0.3%; P < 0.001), but not mortality (2.1% vs. 0.2%; P = 0.12) vs. no procedural thrombotic complication. By comparison, ACUITY minor bleeding increased hospitalization cost by $1,416 (95%CI = 312, $2,519; P = 0.012). ACUITY major bleeding increased cost of hospitalization by $7,894 (95%CI $4,154, $11,635; P < 0.001). CONCLUSIONS IPTE and bleeding complications, though infrequent, are associated with substantial increased cost. These complications should be collected in economic assessments of PCI.
Collapse
Affiliation(s)
- Hector Tamez
- Division of Cardiology, Interventional Section, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Philip Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.,New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Robert W Yeh
- Division of Cardiology, Interventional Section, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Amit P Amin
- Division of Cardiology, Washington University, St. Louis, Missouri
| | - Weihong Fan
- The Medicines Company, Parsippany, New Jersey
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.,New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.,New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - C Michael Gibson
- Division of Cardiology, Interventional Section, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Robert A Harrington
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Deepak L Bhatt
- Division of Cardiology, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Duane S Pinto
- Division of Cardiology, Interventional Section, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|