Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention: Results from the CHAMPION PHOENIX ECONOMICS Study

Catheter Cardiovasc Interv. 2018 Nov 1;92(5):E348-E355. doi: 10.1002/ccd.27638. Epub 2018 May 4.

Abstract

Background: Despite improvements in percutaneous coronary intervention (PCI), intraprocedural thrombotic events (IPTE) and bleeding complications occur and are prognostically important. These have not been included in prior economic studies.

Methods: PHOENIX ECONOMICS was a substudy of the CHAMPION PHOENIX trial, evaluating cangrelor during PCI. Hospital bills were reviewed from 1,171 patients enrolled at 22 of 63 US sites. Costs were estimated using standard methods including resource-based accounting, hospital billing data, and the Medicare fee schedule. Bleeding and IPTE, defined as abrupt vessel closure (transient or sustained), new/suspected thrombus, new clot on wire/catheter, no reflow, side-branch occlusion, procedural stent thrombosis or urgent need for CABG were identified. Costs were calculated according to whether a complication occurred and type of event. Multivariate analyses were used to estimate the incremental costs of IPTE and postprocedural events.

Results: IPTE occurred in 4.3% and were associated with higher catheterization laboratory and overall index hospitalization costs by $2,734 (95%CI $1,117, $4,351; P = 0.001) and $6,354 (95% CI $4,122, $8,586; P < 0.001), respectively. IPTE were associated with MI (35.4% vs. 3.6%; P < 0.001), out-of-laboratory stent thrombosis (4.2% vs. 0.1%; 0 = 0.005), ischemia driven revascularization (12.5% vs. 0.3%; P < 0.001), but not mortality (2.1% vs. 0.2%; P = 0.12) vs. no procedural thrombotic complication. By comparison, ACUITY minor bleeding increased hospitalization cost by $1,416 (95%CI = 312, $2,519; P = 0.012). ACUITY major bleeding increased cost of hospitalization by $7,894 (95%CI $4,154, $11,635; P < 0.001).

Conclusions: IPTE and bleeding complications, though infrequent, are associated with substantial increased cost. These complications should be collected in economic assessments of PCI.

Keywords: bleeding; economic analysis; intra-procedural thrombotic events; myocardial infarction; percutaneous coronary intervention; stent thrombosis.

Publication types

  • Comparative Study
  • Equivalence Trial
  • Multicenter Study

MeSH terms

  • Adenosine Monophosphate / adverse effects
  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / economics
  • Aged
  • Clopidogrel / adverse effects
  • Clopidogrel / economics
  • Coronary Thrombosis / economics*
  • Coronary Thrombosis / etiology
  • Coronary Thrombosis / mortality
  • Coronary Thrombosis / therapy*
  • Cost-Benefit Analysis
  • Double-Blind Method
  • Drug Costs*
  • Female
  • Hemorrhage / chemically induced
  • Hemorrhage / economics*
  • Hemorrhage / mortality
  • Hemorrhage / therapy*
  • Hospital Costs*
  • Hospital Mortality
  • Humans
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Models, Economic
  • Percutaneous Coronary Intervention / adverse effects*
  • Percutaneous Coronary Intervention / economics*
  • Percutaneous Coronary Intervention / mortality
  • Platelet Aggregation Inhibitors / adverse effects*
  • Platelet Aggregation Inhibitors / economics*
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States

Substances

  • Platelet Aggregation Inhibitors
  • Adenosine Monophosphate
  • cangrelor
  • Clopidogrel