Boston Scientific Corporation, Marlborough, MA.
Boston Scientific Corporation, Marlborough, MA.
Am Heart J. 2023 Aug;262:20-28. doi: 10.1016/j.ahj.2023.03.013. Epub 2023 Apr 2.
Acute kidney injury (AKI), including contrast-induced AKI (CI-AKI), is an important complication of percutaneous coronary intervention (PCI), resulting in short- and long-term adverse clinical outcomes. While prior research has reported an increased cost burden to hospitals from CI-AKI, the incremental cost to payers remains unknown. Understanding this incremental cost may inform decisions and even policy in the future. The objective of this study was to estimate the short- and long-term cost to Medicare of AKI overall, and specifically CI-AKI, in PCI.
Patients undergoing inpatient PCI between January 2017 and June 2020 were selected from Medicare 100% fee-for-service data. Baseline clinical characteristics, PCI lesion/procedural characteristics, and AKI/CI-AKI during the PCI admission, were identified from diagnosis and procedure codes. Poisson regression, generalized linear modelling, and longitudinal mixed effects modelling, in full and propensity-matched cohorts, were used to compare PCI admission length of stay (LOS) and cost (Medicare paid amount inflated to 2022 US$), as well as total costs during 1-year following PCI, between AKI and non-AKI patients.
The study cohort included 509,039 patients, of whom 104,033 (20.4%) were diagnosed with AKI and 9,691 (1.9%) with CI-AKI. In the full cohort, AKI was associated with +4.12 (95% confidence interval = 4.10, 4.15) days index PCI admission LOS, +$11,313 ($11,093, $11,534) index admission costs, and +$14,800 ($14,359, $15,241) total 1-year costs. CI-AKI was associated with +3.03 (2.97, 3.08) days LOS, +$6,566 ($6,148, $6,984) index admission costs, and +$13,381 ($12,118, $14,644) cumulative 1-year costs (all results are adjusted for baseline characteristics). Results from the propensity-matched analyses were similar.
AKI, and specifically CI-AKI, during PCI is associated with significantly longer PCI admission LOS, PCI admission costs, and long-terms costs.
急性肾损伤（AKI），包括造影剂诱导的 AKI（CI-AKI），是经皮冠状动脉介入治疗（PCI）的一个重要并发症，导致短期和长期的不良临床结局。虽然先前的研究已经报道了 CI-AKI 给医院带来了更高的成本负担，但支付方的增量成本仍不清楚。了解这一增量成本可能会为未来的决策甚至政策提供信息。本研究的目的是估计 Medicare 因 AKI 总体以及 PCI 中的 CI-AKI 而导致的短期和长期成本。
从 Medicare 100%按服务项目付费数据中选择 2017 年 1 月至 2020 年 6 月期间住院行 PCI 的患者。从诊断和手术代码中确定 PCI 入院时的基线临床特征、PCI 病变/手术特征和 AKI/CI-AKI。在全队列和倾向匹配队列中，使用泊松回归、广义线性模型和纵向混合效应模型，比较 AKI 和非 AKI 患者的 PCI 入院住院时间（LOS）和费用（按 2022 年美元膨胀的 Medicare 支付金额），以及 PCI 后 1 年内的总费用。
研究队列包括 509039 名患者，其中 104033 名（20.4%）被诊断为 AKI，9691 名（1.9%）为 CI-AKI。在全队列中，AKI 与 PCI 入院 LOS 增加 4.12 天（95%置信区间：4.10，4.15）、PCI 入院费用增加 11313 美元（11093 美元，11534 美元）、PCI 后 1 年总费用增加 14800 美元（14359 美元，15241 美元）有关。CI-AKI 与 LOS 增加 3.03 天（2.97，3.08）、PCI 入院费用增加 6566 美元（6148 美元，6984 美元）、PCI 后 1 年总费用增加 13381 美元（12118 美元，14644 美元）有关（所有结果均按基线特征进行调整）。倾向匹配分析的结果相似。
PCI 期间的 AKI，特别是 CI-AKI，与 PCI 入院 LOS、PCI 入院费用和长期费用显著增加有关。
