title: Cost awareness decreases total percutaneous coronary intervention procedural cost: The SHOPPING (Show How Options in Price for Procedures Can Be Influenced Greatly) trial.
abstract: OBJECTIVE
  We initiated the SHOPPING Trial (Show How Options in Price for Procedures can be InflueNced Greatly) to see if percutaneous coronary intervention (PCI) procedures can be performed at a lower cost in a single institution.
  
  
  BACKGROUND
  Procedural practice variability is associated with inefficiency and increased cost. We hypothesized that announcing costs for all supplies during a catheterization procedure and reporting individual operator cost relative to peers would spur cost reduction without affecting clinical outcomes.
  
  
  METHODS
  Baseline costs of 10 consecutive PCI procedures performed by 9 interventional cardiologists were documented during a 90-day interval. Costs were reassessed after instituting cost announcing and peer reporting the next quarter. The intervention involved labeling of all endovascular supplies, equipment, devices, and disposables in the catheterization laboratory and announcement of the unit price for each piece when requested. For each interventionalist, procedure time and costs were measured and analyzed prior to and after the intervention.
  
  
  RESULTS
  We found that total PCI procedural cost was significantly reduced by an average of $234.77 (P = 0.01), equating to a total savings of $21,129.30 over the course of 90 PCI procedures. Major Adverse Cardiac and Cerebrovascular Event (MACCE) rates were similar during both periods (2.3% vs. 3.5%, P = NS).
  
  
  CONCLUSIONS
  Announcing costs in the catheterization laboratory during single vessel PCI and peer reporting leads to cost reduction without affecting clinical outcomes. This intervention may have a role in more complex coronary and peripheral interventional procedures, and in other procedural areas where multiple equipment and device alternatives with variable costs are available. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Tel-Aviv University, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Asher
authors.affiliation: Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Mansour
authors.affiliation: Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Adam
authors.initials: A
authors.lastname: Wheeler
authors.affiliation: Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kendrick
authors.affiliation: Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Michael
authors.initials: M
authors.lastname: Cunningham
authors.affiliation: Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Sahil
authors.initials: S
authors.lastname: Parikh
authors.affiliation: Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Zidar
authors.affiliation: Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Todd
authors.initials: T
authors.lastname: Harford
authors.affiliation: Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Simon
authors.affiliation: Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Vikram S
authors.initials: VS
authors.lastname: Kashyap
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D001364:Awareness; D000072096:Cardiologists / Q000191:economics* / Q000523:psychology; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010380:Peer Review; D062645:Percutaneous Coronary Intervention / Q000191:economics* / Q000295:instrumentation; D010818:Practice Patterns, Physicians' / Q000191:economics*; D015397:Program Evaluation; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: CATH - Catheterization; Diagnostic; ECO - Economica/Cost-Effectiveness; PCI - Percutaneous Coronary Intervention (PCI)