JACC: Same-day PCI discharge vs. overnight cuts costs in half

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Same-day discharge after uncomplicated transradial PCI, in addition to a bolus-only abciximab regimen, reduced medical costs by 50 percent, according to the results of the EASY trial published in the October issue of the Journal of the American College of Cardiology: Cardiovascualar Interventions.

“Same-day home discharge after transradial PCI and a bolus-only abciximab regimen was found to be clinically noninferior to the abciximab standard therapy and overnight hospitalization in patients with various forms of acute coronary syndromes (ACS),” the authors wrote.

To better understand the economics of same-day discharge of uncomplicated PCI plus bolus-only abciximab, Stéphane Rinfret, MD, of the Laval University in Quebec City, and colleagues conducted the EASY (Early Discharge After Transradial Stenting of Coronary Arteries) trial, which enrolled 1,005 patients to compare the results of a same-day discharge and bolus of abciximab (504 patients) and an overnight hospitalization and bolus followed by a 12-hour abciximab infusion (501 patients) after uncomplicated PCI.

The researchers estimated the economic impact of post-PCI healthcare costs (in Canadian dollars) and the short-term economic impact of same-day home discharge.

Rinfret and colleagues found no significant differences in the angiography or PCI equipment or number of stents used between the outpatient group and hospitalization group.

The average post-PCI hospital length of stay was longer in the hospitalization group, 26.5 hours versus 8.9 hours, respectively—a mean difference of 17.7 hours. Within 30 days of PCI, 51 repeat hospitalizations occurred for any cause, 29 patients in the outpatient arm and 21 patients in the hospitalization arm.

After the 30-day follow-up, Rinfret et al estimated the total hospital-based costs to be $891 for the outpatient arm compared to $2,018 for the hospitalization arm, a difference of $1,127.

The mean cumulative healthcare costs per patient were estimated to be $1,117 for the outpatient group versus $2,258 for the hospitalization arm.

The researchers attributed the $1,141 per patient difference in costs to be related to the extra night in hospitalization post-PCI. No differences in follow-up costs for procedures, physician services or medications were found.

“We found that a strategy of same-day home discharge following uncomplicated transradial PCI saved on average $1,141 per patient compared with the post-PCI overnight stay strategy, without any harm to the patients,” the authors wrote. “Such an amount represents a 50 percent relative saving in post-PCI costs.”

The researchers estimated that such a strategy could yield a $1 million savings for every 1,000 outpatients.

“Our findings have important implications, both from the institution and healthcare system perspective,” they wrote.

Rinfret and colleagues estimated that for other periprocedural antithrombotic strategies, such as bivalirudin, which can be stopped after the procedure, a hospital savings of $1,127 per patient would incur in cases of uncomplicated PCI.

“Treatment of coronary artery disease still represents a significant cost burden to the U.S. society, with almost 1.2 million hospital discharges in the U.S. alone in 2006,” the authors wrote. “There is also a major move in the U.S. to pay hospital outpatient rates for elective, uncomplicated PCI, and these payments are about 50 percent of those for inpatient PCI.

“Therefore, U.S. hospitals should have tremendous incentive to identify cost savings for the PCI programs,” the authors concluded.