Gallen Rory A, O'Mahony James F, M Kuntz Karen, McGorrian Catherine, Casserly Ivan P, J Blake Gavin
Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
University College Dublin, Dublin, Ireland.
Open Heart. 2025 Feb 17;12(1):e002988. doi: 10.1136/openhrt-2024-002988.
Percutaneous coronary intervention (PCI) is a well-established treatment for coronary artery disease, one of the most significant causes of morbidity and mortality worldwide. Intracoronary imaging, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has been shown to improve outcomes for patients following PCI by reducing complications and the need for repeat procedures. Uptake remains highly variable, in part due to concerns over up-front costs.
The purpose of this micro-costing analysis was to establish the costs and resource implications of PCI with and without intracoronary imaging.
The costing model considered costs associated with the index procedure and related hospital admission and was designed using data obtained from primary data collection, previously published literature and expert opinion. Unit costs were established through communication with the hospital finance department and industry representatives and were reported in 2024 euro. Costs were categorised as staffing, capital and consumables. Staffing costs were calculated in accordance with local guidelines. Capital costs were averaged over a 10-year period. A sensitivity analysis was conducted to assess the impact of the use of IVUS and OCT during PCI.
The use of intracoronary imaging extends the average procedure time from 45 min to 60 min. The total procedural cost of PCI without intracoronary imaging was €3082. The incremental cost with intracoronary imaging was €752 for IVUS and €884 with OCT.
This study provides robust data on the cost drivers of PCI with intracoronary imaging in Ireland which has not previously been described. This framework may be of use to finance departments and physicians alike when seeking to establish the cost and resource implications of future modifications to PCI procedures, such as the description of the impact of intracoronary imaging in this study.
经皮冠状动脉介入治疗（PCI）是治疗冠状动脉疾病的一种成熟方法，冠状动脉疾病是全球发病和死亡的最重要原因之一。冠状动脉内成像，包括血管内超声（IVUS）和光学相干断层扫描（OCT），已被证明可通过减少并发症和重复手术需求来改善PCI术后患者的预后。其应用率仍然差异很大，部分原因是对前期成本的担忧。
本微观成本分析的目的是确定有无冠状动脉内成像的PCI的成本和资源影响。
成本核算模型考虑了与初次手术及相关住院治疗相关的成本，并利用从原始数据收集、先前发表的文献和专家意见中获得的数据进行设计。单位成本通过与医院财务部门和行业代表沟通确定，并以2024欧元报告。成本分为人员、资本和耗材。人员成本根据当地指南计算。资本成本在10年内平均计算。进行敏感性分析以评估PCI期间使用IVUS和OCT的影响。
使用冠状动脉内成像将平均手术时间从45分钟延长至60分钟。无冠状动脉内成像的PCI总手术成本为3082欧元。冠状动脉内成像的增量成本，IVUS为752欧元，OCT为884欧元。
本研究提供了关于爱尔兰冠状动脉内成像PCI成本驱动因素的有力数据，此前尚未有过描述。当试图确定未来PCI手术修改的成本和资源影响时，如本研究中描述的冠状动脉内成像的影响，该框架可能对财务部门和医生都有用。
