Abstract 3237: The Economic Impact of Same-Day Discharge after Transradial Percutaneous Coronary Intervention and a Single Bolus of Abciximab; an Analysis from the EASY Trial
Background: In patients presenting with an acute coronary syndrome, same-day home discharge (SDD) after an uncomplicated transradial percutaneous coronary intervention (PCI) performed under a single bolus of abciximab was found clinically non-inferior to the usual overnight hospitalization (OH) and an abciximab bolus followed by a 12h infusion.
Objective: To estimate post-PCI health resources cost of trial subjects, and, using cost-minimization, immediate and short-term economic impact of same-day home discharge.
Method: A total of 1005 patients were randomized to either the SDD group (n =504) or the OH (n = 501). As randomization was post-procedure, and PCI resource use showed minimal and non-significant differences, a post-PCI cost analysis was conducted. A hospital-based perspective was used. Detailed per patient information of healthcare resources used immediately post-PCI up to hospital discharge were prospectively collected. Costs were estimated based on 2006 Laval Hospital unit prices, and 2006 costs from the Centre Hospitalier de l’université de Montréal (CHUM) hospital costing system (direct and indirect costs). In addition, patient-reported resources for a period of 30 days post-discharge were examined.
Results: Per hour post-PCI hospital costs were estimated as $113, based on average 2006 cost for all patients hospitalized for angioplasty plus stent (DRG 112) at the CHUM ($5716), net of estimated PCI-related cost ($1131), and divided by average post PCI length-of-stay of subjects. SDD patients stayed an average of 8.9 hours (95%CI from 8.2 to 9.5) post-PCI, compared to 26.5 hours (25.2–27.8) for OH patients. Mean estimated post-PCI hospital costs (including abciximab infusion when used, other medications, nursing time, meals, etc..) were $1004 ($929–$1079) in the SDD group versus $3117 ($2975–$3260) in the OH group, saving, on average, $2113 per patient (p<0.001). Within 30 days of discharge, only 50 patients were rehospitalized, 29 after SD discharge and 21 after OH (p=0.26).
Conclusion: Same-day home discharge after an uncomplicated transradial PCI and a single bolus of abciximab resulted in a 68% relative saving in post PCI costs. In our trial, SDD of 504 patients saved over 1 million dollars to the hospital.