Stevens Mitali, Davis Todd, Munson Sibyl H, Shenoy Apeksha V, Gricar Boye L A, Yapici Halit O, Shaw Andrew D
Global Health Economics & Reimbursement, Edwards Lifesciences, Irvine, CA, USA.
Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA.
Clinicoecon Outcomes Res. 2021 Feb 5;13:109-119. doi: 10.2147/CEOR.S282253. eCollection 2021.
A monitoring pulmonary artery catheter (PAC) is utilized in approximately 34% of the US cardiac surgical procedures. Increased use of PAC has been reported to have an association with complication rates: significant decreases in new-onset heart failure (HF) and respiratory failure (RF), but increases in bacteremia and urinary tract infections. We assessed the impact of increasing PAC adoption on hospital costs among cardiac surgery patients for US-based healthcare systems.
An Excel-based economic model calculated annualized savings for a US hospital with various cardiac surgical volumes and PAC adoption rates. A second model, for an integrated payer-provider health system, analyzed outcomes/costs resulting from the cardiac surgical admission and for the treatment of persistent HF and RF complications in the year following surgery. Model inputs were extracted from published literature, and one-way and probabilistic sensitivity analyses were performed.
For an acute care hospital with 500 procedures/year and 34% PAC adoption, annualized savings equalled $61,806 vs no PAC utilization. An increase in PAC adoption rate led to increased savings of $134,751 for 75% and $170,685 for 95% adoption. Savings ranged from $12,361 to $185,418 at volumes of 100 and 1500 procedures/year, respectively. For an integrated payer-provider health system with the base-case scenario of 3845 procedures/year and 34% PAC adoption, estimated savings were $596,637 for the combined surgical index admission and treatment for related complications over the following year.
PAC utilization in adult cardiac surgery patients results in reduced costs for both acute care hospitals and payer-provider integrated health systems.
在美国，约34%的心脏外科手术使用监测肺动脉导管（PAC）。据报道，PAC使用的增加与并发症发生率有关：新发心力衰竭（HF）和呼吸衰竭（RF）显著减少，但菌血症和尿路感染增加。我们评估了美国医疗系统中PAC使用增加对心脏手术患者住院费用的影响。
基于Excel的经济模型计算了不同心脏手术量和PAC使用率的美国医院的年化节省费用。第二个模型针对综合支付方-医疗机构健康系统，分析了心脏手术入院以及术后一年持续性HF和RF并发症治疗的结果/成本。模型输入数据取自已发表的文献，并进行了单因素和概率敏感性分析。
对于一家每年进行500例手术且PAC使用率为34%的急症医院，与不使用PAC相比，年化节省费用为61,806美元。PAC使用率的增加导致使用率为75%时节省费用增加134,751美元，使用率为95%时节省费用增加170,685美元。每年手术量为100例和1500例时，节省费用分别为12,361美元至185,418美元。对于一个综合支付方-医疗机构健康系统，在基本情况为每年3845例手术且PAC使用率为34%的情况下，预计下一年手术指数入院及相关并发症治疗的综合节省费用为596,637美元。
在成人心脏手术患者中使用PAC可降低急症医院和支付方-医疗机构综合健康系统的成本。
