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

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: Compa...

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Bibliographic Details
Published in:Heart (British Cardiac Society) 2007-02, Vol.93 (2), p.195-199
Main Authors: Denvir, M A, Lee, A J, Rysdale, J, Prescott, R J, Eteiba, H, Starkey, I R, Pell, J P, Walker, A
Format: Article
Language:English
Subjects:
Ambulatory Care - economics
Angioplasty, Balloon, Coronary - economics
Angioplasty, Balloon, Coronary - instrumentation
Angioplasty, Balloon, Coronary - trends
bare metal stents
Biological and medical sciences
BMS
Body mass index
CABG
Capital costs
Cardiology. Vascular system
Chi-Square Distribution
Clinical outcomes
Confidence intervals
coronary artery bypass graft
Coronary Care Units - economics
Coronary Disease - economics
Coronary Disease - therapy
Coronary heart disease
Coronary vessels
Costs and Cost Analysis
Data collection
Diabetes
Diseases of the cardiovascular system
Epidemiology
Female
General aspects
Heart
Heart attacks
Heart surgery
Humans
Hypertension
Interventional Cardiology
Laboratories
Length of Stay - economics
Male
Medical Record Linkage
Medical sciences
Middle Aged
Mortality
PCI
percutaneous coronary intervention
Public health. Hygiene
Public health. Hygiene-occupational medicine
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Reoperation
Stents
Treatment Outcome
Veins & arteries
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Summary: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
ISSN:1355-6037
1468-201X
DOI:10.1136/hrt.2006.090134