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

Denvir, M., Lee, A., Rysdale, J., Starkey, I., Prescott, R., Eteiba, H., Pell, J. and Walker, A. (2007) Effects of changing clinical practice on costs and outcomes of percutaneous coronary intervention between 1998 and 2002. Heart, 93(2), pp. 195-199. (doi:10.1136/hrt.2006.090134)

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Abstract

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 (1158) v £1785 (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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Walker, Dr Andrew and Eteiba, Dr Hany and Pell, Professor Jill
Authors: Denvir, M., Lee, A., Rysdale, J., Starkey, I., Prescott, R., Eteiba, H., Pell, J., and Walker, A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
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Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037

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