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 |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Eteiba, Professor Hany and Pell, Professor Jill and Walker, Dr Andrew |
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 > School of Health & Wellbeing > Robertson Centre College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences ?? 20206000 ?? |
Journal Name: | Heart |
Publisher: | BMJ Publishing Group |
ISSN: | 1355-6037 |
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