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Effects of changing clinical practice on costs and outcomes of percutaneous coronary intervention between 1998 and 2002
  1. M A Denvir1,
  2. A J Lee2,
  3. J Rysdale1,
  4. R J Prescott2,
  5. H Eteiba3,
  6. I R Starkey1,
  7. J P Pell3,
  8. A Walker4
  1. 1Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, UK
  2. 2Medical Statistics Unit, University of Edinburgh, Teviot Place, Edinburgh, UK
  3. 3Medical Cardiology, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, UK
  4. 4Department of Statistics and Health Economics, University of Glasgow, Glasgow, UK
  1. Correspondence to:
    Dr M Denvir
    Centre for Cardiovascular Research, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; mdenvir{at}staffmail.ed.ac.uk

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.

  • BMS, bare metal stents
  • CABG, coronary artery bypass graft
  • PCI, percutaneous coronary intervention

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Footnotes

  • Published Online First 18 July 2006

  • Funding: This study was funded by the Chief Scientists Office, Scottish Executive, UK

  • Competing interests: None.

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