Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention

Results from the CHAMPION PHOENIX ECONOMICS Study

on behalf of the CHAMPION PHOENIX ECONOMICS Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)E348-E355
JournalCatheterization and Cardiovascular Interventions
Volume92
Issue number5
DOIs
StatePublished - Nov 1 2018
Externally publishedYes

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Percutaneous Coronary Intervention
Hemorrhage
Costs and Cost Analysis
Hospitalization
Thrombosis
Stents
Fee Schedules
Economics
Medicare
Catheterization
Multivariate Analysis
Ischemia
Catheters
Mortality

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{faa998bf360d4297b947f18a5c3a028a,
title = "Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention: Results from the CHAMPION PHOENIX ECONOMICS Study",
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.",
author = "{on behalf of the CHAMPION PHOENIX ECONOMICS Investigators} and Hector Tamez and Philippe Genereux and Yeh, {Robert W.} and Amin, {Amit P.} and Weihong Fan and White, {Harvey D.} and Kirtane, {Ajay J.} and Stone, {Gregg W.} and Gibson, {C. Michael} and Harrington, {Robert A.} and Bhatt, {Deepak L.} and Pinto, {Duane S.}",
year = "2018",
month = "11",
day = "1",
doi = "10.1002/ccd.27638",
language = "English (US)",
volume = "92",
pages = "E348--E355",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",
number = "5",

}

Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention : Results from the CHAMPION PHOENIX ECONOMICS Study. / on behalf of the CHAMPION PHOENIX ECONOMICS Investigators.

In: Catheterization and Cardiovascular Interventions, Vol. 92, No. 5, 01.11.2018, p. E348-E355.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention

T2 - Results from the CHAMPION PHOENIX ECONOMICS Study

AU - on behalf of the CHAMPION PHOENIX ECONOMICS Investigators

AU - Tamez, Hector

AU - Genereux, Philippe

AU - Yeh, Robert W.

AU - Amin, Amit P.

AU - Fan, Weihong

AU - White, Harvey D.

AU - Kirtane, Ajay J.

AU - Stone, Gregg W.

AU - Gibson, C. Michael

AU - Harrington, Robert A.

AU - Bhatt, Deepak L.

AU - Pinto, Duane S.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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.

AB - 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.

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U2 - 10.1002/ccd.27638

DO - 10.1002/ccd.27638

M3 - Article

VL - 92

SP - E348-E355

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 5

ER -