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CPORT-E: PCI costs higher in hospitals without onsite cardiac surgery unit
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LOS ANGELES — An economic analysis of the CPORT-E trial revealed that PCI costs were higher when performed at hospitals without an onsite cardiac surgery unit when compared with hospitals equipped with a cardiac surgery unit.
Eric L. Eisenstein, DBA, assistant professor of medicine and community and family medicine at Duke University School of Medicine, and colleagues examined whether cardiac surgery-equipped hospitals can perform PCI at a similar cost to non-surgery hospitals.
The researchers analyzed billing data from 18,273 patients (mean age, 64 years; 79% white; 63% men) treated at 59 hospitals in 10 states.
Nine months after surgery, average cumulative medical costs were $23,991 in surgery-equipped hospitals vs. $25,460 in non-surgery hospitals. Two factors contributed to this difference: the study protocol required non-surgery hospitals to use ICUs for post-angioplasty care and patients treated at these hospitals were more likely than those receiving angioplasty at cardiac-equipped hospitals to be readmitted 9 months after treatment, according to the researchers.
Eric L. Eisenstein
“The decision to require sites without surgical back-up to send their patients to the ICU for post-procedure care had a dramatic effect on this study’s outcomes. Even though the sites without surgical back-up had shorter lengths of stay, they had higher ICU room costs and total room costs,” Eisenstein said during a press conference.
He also noted differences in cost between low-volume and high-volume hospitals. Costs associated with PCI were higher at low-volume hospitals, particularly those without cardiac surgery units.
“[Results showed] a nonsignificant difference in cardiac procedure costs,” Eisenstein said. “These were not related to differences in implant costs but totally in the cath lab, so we’re currently looking at whether differences in volume were causing this difference in cath-lab costs.”
The main C-PORT-E clinical trial found that elective angioplasty performed in hospitals without on-site cardiac surgery was as safe and effective as those performed at hospitals with on-site cardiac surgery.
For more information:
Eisenstein EL. Late-breaking clinical trials: Health economics and quality of life in contemporary trials. Presented at: the American Heart Association Scientific Sessions; Nov. 3-7, 2012; Los Angeles.
Disclosure: Eisenstein reports research support from Eli Lilly and Medtronic Endovascular Therapies.