Effects of changing clinical practice on costs and outcomes of percutaneous coronary intervention between 1998 and 2002

M A Denvir, A J Lee, J Rysdale, R J Prescott, H Eteiba, I R Starkey, J P Pell, A Walker

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

AIM: To assess the effect of changing clinical practice on the costs and outcomes of percutaneous coronary intervention (PCI) between 1998 and 2002. SETTING: Two tertiary interventional centres.

PATIENTS: Consecutive patients undergoing PCI over a 12-month period between 1998 and 2002.

DESIGN: Comparative observational study of costs and 12-month clinical outcomes of consecutive PCI procedures in 1998 (n = 1047) and 2002 (n = 1346). Clinical data were recorded in the Scottish PCI register. Repeat PCI, coronary artery bypass graft and mortality were obtained by record linkage. Costs of equipment were calculated using a computerised bar-code system and standard National Health Service reference costs.

RESULTS: Between 1998 and 2002, the use of bare metal stents increased from 44% to 81%, and the use of glycoprotein IIB/IIIA inhibitors increased from 0% to 14% of cases. During this time, a significant reduction was observed in repeat target-vessel PCI (from 8.4% to 5.1%, p = 0.001), any repeat PCI (from 11.7% to 9.2%, p = 0.05) and any repeat revascularisation (from 15.1% to 11.3%, p = 0.009) within 12 months. Significantly higher cost per case in 2002 compared with 1998 (mean (standard deviation) 2311 pounds (1158) v 1785 pounds (907), p<0.001) was mainly due to increased contribution from bed-day costs in 2002 (45.0% (16.3%) v 26.2% (12.6%), p = 0.01) associated with non-elective cases spending significantly longer in hospital (6.22 (4.3) v 4.6 (4.3) days, p = 0.01).

CONCLUSIONS: Greater use of stents and glycoprotein IIb/IIIa inhibitors between 1998 and 2002 has been accompanied by a marked reduction in the need for repeat revascularisation. Longer duration of hospital stay for non-elective cases is mainly responsible for increasing costs. Strategies to reduce the length of stay could considerably reduce the costs of PCI.
Original languageEnglish
Pages (from-to)195-9
Number of pages5
JournalHeart
Volume93
Issue number2
DOIs
Publication statusPublished - Feb 2007

Keywords / Materials (for Non-textual outputs)

  • Ambulatory Care
  • Angioplasty, Balloon, Coronary
  • Chi-Square Distribution
  • Coronary Care Units
  • Coronary Disease
  • Costs and Cost Analysis
  • Female
  • Humans
  • Length of Stay
  • Male
  • Medical Record Linkage
  • Middle Aged
  • Reoperation
  • Stents
  • Treatment Outcome

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