Economic impact of same-day home discharge after uncomplicated transradial percutaneous coronary intervention and bolus-only abciximab regimen.
OBJECTIVE
This study sought to estimate the economic impact of same-day home discharge compared with overnight hospitalization after transradial percutaneous coronary intervention (PCI).


BACKGROUND
Same-day home discharge after transradial PCI and a bolus-only abciximab regimen was found to be clinically noninferior to the abciximab standard therapy and overnight hospitalization in patients with various forms of acute coronary syndromes.


METHODS
In the EASY (Early Discharge After Transradial Stenting of Coronary Arteries) trial, 1,005 patients were randomized after a bolus of abciximab and uncomplicated transradial coronary stenting, either to same-day home discharge and no infusion (outpatient group) or to overnight hospitalization and 12-h abciximab infusion (overnight-stay group). We estimated post-PCI health care cost (in Canadian dollars) of trial subjects and short-term economic impact of same-day home discharge. As randomization was done after the procedure, outcomes were similar, and PCI resource use showed minimal and nonsignificant differences, a post-PCI cost-minimization analysis was conducted. Detailed per-patient information of health care resources used immediately after PCI up to 30 days was collected.


RESULTS
Mean post-PCI hospital stay was 8.9 h for outpatients versus 26.5 h for overnight-stay patients (p < 0.001). At 30-day follow-up, the mean cumulative medical cost per outpatient was $1,117 ± $1,554 versus $2,258 ± $1,328 for overnight-stay patients. The mean difference of $1,141 (95% confidence interval: $962 to $1,320) was mainly due to the extra night for overnight hospital stay.


CONCLUSIONS
In a real-world setting, same-day home discharge after uncomplicated transradial PCI and a bolus-only abciximab regimen resulted in a 50% relative reduction in medical costs. Extension of this outpatient strategy would be welcomed by the hospitals and reimbursement systems in a context of increasing demand for health care cost reduction. (Early Discharge After Transradial Stenting of Coronary Arteries [EASY]; NCT00169819).
Interventional Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada. Stephane.Rinfret@criucpq.ulaval.ca
Stéphane
S
Rinfret
Wendy Ann
WA
Kennedy
Jean
J
Lachaine
Anne
A
Lemay
Josep
J
Rodés-Cabau
David J
DJ
Cohen
Olivier
O
Costerousse
Olivier F
OF
Bertrand
D000077284:Abciximab; D054058:Acute Coronary Syndrome / Q000191:economics / Q000628:therapy*; D000553:Ambulatory Care / Q000191:economics; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage* / Q000191:economics; D007902:Length of Stay; D018803:Models, Economic; D010351:Patient Discharge / Q000191:economics*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000191:economics; D011446:Prospective Studies; D011792:Quebec; D017534:Radial Artery; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab