The economic burden of complications during percutaneous coronary intervention

Kurt M. Jacobson, Kirsten Hall Long, Erin K. McMurtry, James M Naessens, Charanjit S. Rihal

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Technological advances have enabled percutaneous coronary intervention (PCI) to be applied with expanding indications. However, escalating costs are of concern. This study assessed the incremental medical costs of 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. 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) and bleeding of clinical significance. Administrative data were used to estimate total costs in standardised, year 2004, constant-US dollars. We used generalised linear modeling to estimate costs associated with complications adjusting for baseline and procedural characteristics. Results: 1071 (13.2%) of patients experienced complications during hospitalisation. Patients experiencing complications were older, more likely to present with emergent PCI, recent or prior myocardial infarction, multi-vessel disease, and comorbid conditions than patients who did not experience these events. Unadjusted total costs were, on average, $27 865 ± $39 424 for complicated patient episodes compared to $12 279 ± $6796 for episodes that were complication free (p<0.0001). Adjusted mean costs were $6984 higher for complicated PCIs compared with uncomplicated PCI episodes (95% CI of cost difference: $5801, $8168). Incremental costs associated with isolated bleeding events, MACCE, or for both bleeding and MACCE events were $5883, $5086, and $15 437, respectively (p<0.0001). Conclusions: This high-volume study highlights the significant economic burden associated with procedural complications. Resources and systems approaches to minimising clinical and economic complications in PCI are warranted.

Original languageEnglish (US)
Pages (from-to)154-159
Number of pages6
JournalQuality and Safety in Health Care
Volume16
Issue number2
DOIs
StatePublished - Apr 2007

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Percutaneous Coronary Intervention
Economics
Costs and Cost Analysis
Hemorrhage
Registries
Hospitalization
Myocardial Infarction

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health
  • Nursing(all)

Cite this

The economic burden of complications during percutaneous coronary intervention. / Jacobson, Kurt M.; Long, Kirsten Hall; McMurtry, Erin K.; Naessens, James M; Rihal, Charanjit S.

In: Quality and Safety in Health Care, Vol. 16, No. 2, 04.2007, p. 154-159.

Research output: Contribution to journalArticle

Jacobson, Kurt M. ; Long, Kirsten Hall ; McMurtry, Erin K. ; Naessens, James M ; Rihal, Charanjit S. / The economic burden of complications during percutaneous coronary intervention. In: Quality and Safety in Health Care. 2007 ; Vol. 16, No. 2. pp. 154-159.
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abstract = "Background: Technological advances have enabled percutaneous coronary intervention (PCI) to be applied with expanding indications. However, escalating costs are of concern. This study assessed the incremental medical costs of 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. 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) and bleeding of clinical significance. Administrative data were used to estimate total costs in standardised, year 2004, constant-US dollars. We used generalised linear modeling to estimate costs associated with complications adjusting for baseline and procedural characteristics. Results: 1071 (13.2{\%}) of patients experienced complications during hospitalisation. Patients experiencing complications were older, more likely to present with emergent PCI, recent or prior myocardial infarction, multi-vessel disease, and comorbid conditions than patients who did not experience these events. Unadjusted total costs were, on average, $27 865 ± $39 424 for complicated patient episodes compared to $12 279 ± $6796 for episodes that were complication free (p<0.0001). Adjusted mean costs were $6984 higher for complicated PCIs compared with uncomplicated PCI episodes (95{\%} CI of cost difference: $5801, $8168). Incremental costs associated with isolated bleeding events, MACCE, or for both bleeding and MACCE events were $5883, $5086, and $15 437, respectively (p<0.0001). Conclusions: This high-volume study highlights the significant economic burden associated with procedural complications. Resources and systems approaches to minimising clinical and economic complications in PCI are warranted.",
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AB - Background: Technological advances have enabled percutaneous coronary intervention (PCI) to be applied with expanding indications. However, escalating costs are of concern. This study assessed the incremental medical costs of 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. 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) and bleeding of clinical significance. Administrative data were used to estimate total costs in standardised, year 2004, constant-US dollars. We used generalised linear modeling to estimate costs associated with complications adjusting for baseline and procedural characteristics. Results: 1071 (13.2%) of patients experienced complications during hospitalisation. Patients experiencing complications were older, more likely to present with emergent PCI, recent or prior myocardial infarction, multi-vessel disease, and comorbid conditions than patients who did not experience these events. Unadjusted total costs were, on average, $27 865 ± $39 424 for complicated patient episodes compared to $12 279 ± $6796 for episodes that were complication free (p<0.0001). Adjusted mean costs were $6984 higher for complicated PCIs compared with uncomplicated PCI episodes (95% CI of cost difference: $5801, $8168). Incremental costs associated with isolated bleeding events, MACCE, or for both bleeding and MACCE events were $5883, $5086, and $15 437, respectively (p<0.0001). Conclusions: This high-volume study highlights the significant economic burden associated with procedural complications. Resources and systems approaches to minimising clinical and economic complications in PCI are warranted.

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