Economic assessment of rheolytic thrombectomy versus intracoronary urokinase for treatment of extensive intracoronary thrombus: Results from a randomized clinical trial.
BACKGROUND
Despite advances in mechanical and pharmacologic therapy, thrombus-containing lesions are at high risk for adverse events and remain a challenging subset for percutaneous coronary revascularization. Recently, rheolytic thrombectomy with the AngioJet device has been shown to safely remove intracoronary thrombus, but the overall cost-effectiveness of this technique is unknown.


METHODS
We determined in-hospital and 1-year follow-up costs for 349 patients with overt intracoronary thrombus who were randomly assigned to treatment with intracoronary urokinase (6- to 30-hour infusion followed by definitive revascularization; n = 169) or immediate thrombectomy with the AngioJet device (n = 180) as part of the Vein Graft AngioJet Study (VeGAS) 2 trial. Catheterization laboratory costs were based on measured resource utilization and 1998 unit costs, whereas all other costs were estimated from hospital charges and cost center-specific cost-to-charge ratios.


RESULTS
Compared with urokinase, rheolytic thrombectomy reduced the incidence of periprocedural myocardial infarction (12.8% vs 30.3%, P <.001) and major hemorrhagic complications (2.8% vs 11.2%, P <.001) and shortened length of stay by nearly 1 day (4.2 vs 4.9 days; P =.02). As a result, AngioJet treatment reduced procedural costs, hospital room/nursing costs, and ancillary costs with resulting hospital cost savings of approximately $3500 per patient during the initial hospitalization ($15,311 vs $18,841, P <.001). These cost savings were maintained at 1 year of follow-up ($24,389 vs $29,109, P <.001).


CONCLUSIONS
Compared with standard treatment with intracoronary urokinase, rheolytic thrombectomy both improves clinical outcomes and reduces overall medical care costs for patients with extensive intracoronary thrombus.
Cohen
D J
DJ
Harvard Clinical Research Institute and the Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. djc@hsph.harvard.edu
Ramee
S
S
Baim
D S
DS
Sharma
S
S
Carrozza
J P
JP
Cosgrove
R
R
Jones
N
N
Berezin
R H
RH
Cutlip
D E
DE
Ho
K K
KK
Kuntz
R E
RE
D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000379:methods; D003328:Coronary Thrombosis / Q000188:drug therapy* / Q000191:economics / Q000601:surgery*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D018056:Hemorheology; D006801:Humans; D007261:Infusions, Intra-Arterial; D017131:Thrombectomy / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator