Economic appraisal of the angioplasty procedures performed in 2004 in a high-volume diagnostic and interventional cardiology unit.
OBJECTIVE
Growing interest in the use of drug-eluting stents (DESs) in coronary angioplasty has prompted the Healthcare Agency of the Emilia Romagna Region to draw up recommendations for their appropriate clinical use in high-risk patients. Since the adoption of any new technology necessitates economic appraisal, we analysed the resource consumption of the various types of angioplasty procedures and the impact on the budget of a cardiology department.


METHODS
A retrospective economic appraisal was carried out on the coronary angioplasty procedures performed in 2004 in the Department of Interventional Cardiology of Reggio Emilia. On the basis of the principles of activity-based costing, detailed hospital costs were estimated for each procedure and compared with the relevant diagnosis-related group (DRG) reimbursement.


RESULTS
In 2004, the Reggio Emilia hospital performed 806 angioplasty procedures for a total expenditure of euro 5,176,268. These were 93 plain old balloon angioplasty procedures (euro 487,329), 401 procedures with bare-metal stents (euro 2,380,071), 249 procedures with DESs (euro 1,827,386) and 63 mixed procedures (euro 481,480). Reimbursements amounted to euro 5,816,748 (11% from plain old balloon angioplasty, 50% from bare-metal stent, 31% from DES and 8% from mixed procedures) with a positive margin of about euro 680,480 between costs incurred and reimbursements obtained, even if the reimbursement for DES and mixed procedures was not covering all the incurred costs.


CONCLUSIONS
Analysis of the case-mix of procedures revealed that an overall positive margin between costs and DRG reimbursements was achieved. It therefore emerges that adherence to the indications of the Healthcare Agency of the Emilia Romagna Region for the appropriate clinical use of DESs is economically sustainable from the hospital enterprise point of view, although the DRG reimbursements are not able to differentiate among resource consumptions owing to the adoption of innovative technologies.
Manari
Antonio
A
Department of Interventional Cardiology, 'Santa Maria Nuova' Hospital, Reggio Emilia, Italy.
Costa
Elena
E
Scivales
Alessandro
A
Ponzi
Patrizia
P
Di Stasi
Francesca
F
Guiducci
Vincenzo
V
Pignatelli
Gianluca
G
Giacometti
Paola
P
D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D016507:Cardiology Service, Hospital / Q000191:economics*; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics; D054855:Drug-Eluting Stents / Q000191:economics; D006801:Humans; D007558:Italy; D012189:Retrospective Studies; D015607:Stents / Q000191:economics