Abstract 9781: Cost-Effectiveness of Same-Day Discharge After Elective Percutaneous Coronary Intervention
Objective: Same-day discharge (SDD) appears to be safe in highly selected patients undergoing PCI, however the economic impact of SDD compared to overnight observation has not been comprehensively assessed.
Methods: We developed a decision-analytic Markov model to compare SDD to overnight observation post-PCI (Figure). Patients were followed from index PCI over remaining lifetime, including the possibility of future revascularizations. Inputs were derived from registries, RCTs, and meta-analyses. We adjusted mortality rates for having had a prior adverse procedural outcome. Costs were estimated using micro-costing (2012 USD), and outcomes were measured in QALYs, both considered from a societal perspective and discounted at 3% annually.
Results: Base case analysis demonstrated that SDD cost $1,639 less but delivered 0.0028 fewer QALYs ($585,000 saved per QALY lost) compared to overnight observation. This result was sensitive to adverse outcome probabilities. SDD cost less and provided more QALYs when the probabilities of adverse outcomes for SDD were lower (<0.57% death, <0.60% major bleeding, or <2.32% MI) or when the probabilities of adverse outcomes for overnight observation were higher (>0.63% death, >0.90% major bleeding, or >2.89% MI). However, SDD cost more and was less effective if rates of SDD adverse events were substantially higher (>6.46% for MI) but still within the 95% confidence interval. Probabilistic sensitivity analyses revealed that SDD was frequently cost-effective even at high willingness-to-pay thresholds.
Conclusion: SDD appears to be cost-effective if its safety profile is confirmed to be nearly identical to overnight observation. The attractiveness of SDD may depend on the ability of health systems to re-allocate resources to achieve anticipated cost savings, and to monitor and respond to adverse events out of the hospital.
- © 2013 by American Heart Association, Inc.