Intraprocedural thrombotic events add $3,600 to hospital costs

An intraprocedural thrombotic event in a patient with non-ST-segment elevation acute coronary syndromes (NSTEACS) adds approximately $3,600 to hospital costs, according to an economic analysis of the ACUITY trial that was published in the July issue of Catheterization and Cardiovascular Interventions.

Senior author Gregg W. Stone, MD, of Columbia University Medical Center in New York City, and colleagues used data from ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy), an international, multicenter clinical trial that randomized 13,819 patients with NSTEACS to one of three different antithrombotic strategies. In ACUITY, 3.5 percent of patients experienced an intraprocedural thrombotic event. Stone et al defined an intraprocedural thrombotic event as intraprocedural stent thrombosis, new or increasing thrombus, abrupt vessel closure, no reflow, slow flow or distal embolization.

The economic study included the 1,307 patients who underwent PCI and had angiographic and economic data. The study focused on in-hospital and 30-day costs (2012 dollars). The rate of intraprocedural thrombotic events in ACUITY was similar between patients with and without the angiographic and economic data.

The rate of at least one major complication was higher in patients who experienced an intraprocedural thrombotic event compared to those who did not have such an event at both the index hospitalization and at 30 days (48.1 percent vs. 30.6 percent and 48.1 percent vs. 34.7 percent). The mean duration of a PCI procedure was longer in patients with an intraprocedural thrombotic event (54.9 minutes vs. 32.4 minutes) and the length of hospital stay was longer (4.6 days vs. 2.7 days).

In adjusted cost analyses, an intraprocedural thrombotic event was associated with increased in-hospital and 30-days costs of 19.5 percent and 18.9 percent, or approximately $3,600 per event.

“[T]hese findings suggest that [an intraprocedural thrombotic event] adds approximate $126 per acute coronary syndromes (ACS) PCI patient to the hospital cost,” they wrote. They calculated that based on the number of ACS PCI procedures performed annually in the U.S., these events may add about $38 million to healthcare costs a year. “Thus, identifying strategies to reduce [intraprocedural thrombotic events] may substantially reduce healthcare expenditures as well as avoid serious adverse clinical events,” they wrote.

The Medicines Company funded ACUITY.