Costs Associated With Access Site and Same-Day Discharge Among Medicare Beneficiaries Undergoing Percutaneous Coronary Intervention
| Autor: | Sunil V. Rao, Helmut Giersiefen, David J. Cohen, Steven P. Marso, John A. House, John A. Spertus, Dmitri Baklanov, David M. Safley, Adnan K. Chhatriwalla, Mark E. Patterson, Amit P. Amin |
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| Rok vydání: | 2017 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Health economics business.industry Inverse probability weighting medicine.medical_treatment Medicare beneficiary Percutaneous coronary intervention 030204 cardiovascular system & hematology Confidence interval 03 medical and health sciences 0302 clinical medicine Propensity score matching Conventional PCI Emergency medicine Medicine 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Intensive care medicine health care economics and organizations Same day discharge |
| Zdroj: | JACC: Cardiovascular Interventions. 10:342-351 |
| ISSN: | 1936-8798 |
| Popis: | Objectives The aim of this study was to examine the independent impact of various care pathways, including those involving transradial intervention (TRI) and same-day discharge (SDD) after elective percutaneous coronary intervention (PCI), on hospital costs. Background PCI is associated with costs of $10 billion annually. Alternative payment models for PCI are being implemented, but few data exist on strategies to reduce costs. Various PCI care pathways, including TRI and SDD, exist, but their association with costs and outcomes is unknown. Methods In total, 279,987 PCI patients eligible for SDD in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims files were analyzed. Hospital costs in 2014 U.S. dollars were estimated using cost-to-charge ratios. Propensity scores for TRI and SDD, with propensity adjustment via inverse probability weighting, was performed. Results Of the 279,987 PCI procedures, TRI was used in 9.0% (13.5% of which were SDD), and SDD was used in 5.3% of cases (23.1% of which were TRI). TRI (vs. transfemoral intervention) was associated with lower adjusted costs of $916 (95% confidence interval [CI]: $778 to $1,035), as was SDD ($3,502; 95% CI: $3,486 to $3,902). The adjusted cost associated with TRI and SDD was $13,389 (95% CI: $13,161 to $13,607), while the cost associated with transfemoral intervention and non-same-day discharge was $17,076 (95% CI: $16,999 to $17,147), a difference of $3,689 (95% CI: $3,486 to $3,902; p Conclusions Among Medicare beneficiaries, TRI with SDD was independently associated with fewer complications and lower in-hospital costs. These findings have important implications for changing the current PCI care pathways to improve outcomes and reduce costs. |
| Databáze: | OpenAIRE |
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