Economic Impact of Same-Day Home Discharge After Uncomplicated Transradial Percutaneous Coronary Intervention and Bolus-Only Abciximab Regimen

Autor: Josep Rodés-Cabau, Jean Lachaine, Wendy Kennedy, Stéphane Rinfret, Anne Lemay, Olivier Costerousse, Olivier F. Bertrand, David Cohen
Rok vydání: 2010
Předmět:
medicine.medical_specialty
Time Factors
Randomization
Abciximab
Cost-Benefit Analysis
medicine.medical_treatment
same-day discharge
Drug Costs
law.invention
Immunoglobulin Fab Fragments
Randomized controlled trial
Cost Savings
law
Angioplasty
cost
Ambulatory Care
medicine
Humans
Prospective Studies
cardiovascular diseases
Acute Coronary Syndrome
Angioplasty
Balloon
Coronary
Hospital Costs
Early discharge
business.industry
percutaneous coronary intervention
Quebec
Antibodies
Monoclonal
Percutaneous coronary intervention
transradial
Health Care Costs
Length of Stay
Patient Discharge
Surgery
Regimen
Models
Economic
Treatment Outcome
surgical procedures
operative
Radial Artery
Conventional PCI
Emergency medicine
Stents
business
Cardiology and Cardiovascular Medicine
Platelet Aggregation Inhibitors
medicine.drug
Zdroj: JACC: Cardiovascular Interventions. 3(10):1011-1019
ISSN: 1936-8798
DOI: 10.1016/j.jcin.2010.07.011
Popis: ObjectivesThis study sought to estimate the economic impact of same-day home discharge compared with overnight hospitalization after transradial percutaneous coronary intervention (PCI).BackgroundSame-day home discharge after transradial PCI and a bolus-only abciximab regimen was found to be clinically noninferior to the abciximab standard therapy and overnight hospitalization in patients with various forms of acute coronary syndromes.MethodsIn the EASY (Early Discharge After Transradial Stenting of Coronary Arteries) trial, 1,005 patients were randomized after a bolus of abciximab and uncomplicated transradial coronary stenting, either to same-day home discharge and no infusion (outpatient group) or to overnight hospitalization and 12-h abciximab infusion (overnight-stay group). We estimated post-PCI health care cost (in Canadian dollars) of trial subjects and short-term economic impact of same-day home discharge. As randomization was done after the procedure, outcomes were similar, and PCI resource use showed minimal and nonsignificant differences, a post-PCI cost-minimization analysis was conducted. Detailed per-patient information of health care resources used immediately after PCI up to 30 days was collected.ResultsMean post-PCI hospital stay was 8.9 h for outpatients versus 26.5 h for overnight-stay patients (p < 0.001). At 30-day follow-up, the mean cumulative medical cost per outpatient was $1,117 ± $1,554 versus $2,258 ± $1,328 for overnight-stay patients. The mean difference of $1,141 (95% confidence interval: $962 to $1,320) was mainly due to the extra night for overnight hospital stay.ConclusionsIn a real-world setting, same-day home discharge after uncomplicated transradial PCI and a bolus-only abciximab regimen resulted in a 50% relative reduction in medical costs. Extension of this outpatient strategy would be welcomed by the hospitals and reimbursement systems in a context of increasing demand for health care cost reduction. (Early Discharge After Transradial Stenting of Coronary Arteries [EASY]; NCT00169819)
Databáze: OpenAIRE
Externí odkaz: