Slideshow | Impact of anti-thombin therapy on hospital cost and length of stay in adult patients undergoing angioplasty

Neeraj R. Bajaj, Weihong Fan, Howard A. Cohen, Kirk N. Garratt

WASHINGTON, D.C.—The use of bivalirudin (Angiomax, The Medicines Company) was associated with lower costs and shorter lengths of hospital stay following PCI compared with heparin use, based on an unselected patient sample, the results of which were presented Sept. 22 at the annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF).

The economic impact of bivalirudin or heparin use, with or without a glycoprotein IIb/IIIa inhibitor (GPI), in unselected patients is “uncertain,” according to study presenter Neeraj Bajaj, MD, from Lenox Hill Heart and Vascular Institute in New York City. He and his colleagues sought to evaluate the impact of anti-thrombin use on length of hospital stay.

The researchers evaluated the Premier Perspective Database, a U.S. clinical and economic data bank to assess outcomes among adult PCI patients treated with bivalirudin, bivalirudin+GPI, heparin or heparin+GPI. They extracted data from 299 teaching, non-teaching, urban and rural hospitals of varying sizes over a 50-month period.

They reviewed 640,110 PCI admissions. However, only 452,044 remained after excluding juveniles and those with incomplete data, CABG during that hospitalization or outlier values (length of stay of greater than 90 days or costs greater than $1 million).

Bajaj reported that the unadjusted means of length of post-PCI hospital stay and hospital costs were:

• Bivalirudin: 0.8 days and $13,927;
• Bivalirudin+GPI: 1.4 days and $17,095;
• Heparin: 1.5 days and $15,943; and
• Heparin+GPI: 1.6 days and $16,710.

 
After the researchers adjusted for patient and hospital differences, compared with heparin+GPI, post- PCI length of hospital stay remained shorter with bivalirudin, and unchanged with heparin and bivalirudin+GPI.

Bajaj said the findings were “similar for patients with bleeding complications.” For patients without bleeding complications, all therapies lowered length of hospital stay compared with heparin+GPI, but bivalirudin alone was associated with the “greatest reduction,” he said.
 
“Compared with heparin+GPI, bivalirudin [alone] and heparin [alone] were associated with cost reductions of $1,116 and $650, respectively, while bivalirudin was associated with a cost increase of $1,320,” Bajaj reported.

Among patients with bleeding complications, only bivalirudin was associated with lower costs, while heparin was “neutral” and bivalirudin+GPI was more expensive, according to the researchers.

Bajaj noted that based on these data, savings were recognized among patients with and without bleeding complications.