1
|
Lee P, Brennan A, Dinh D, Stub D, Lefkovits J, Reid CM, Zomer E, Chin K, Liew D. The cost-effectiveness of radial access percutaneous coronary intervention: A propensity-score matched analysis of Victorian data. Clin Cardiol 2022; 45:435-446. [PMID: 35191069 PMCID: PMC9019896 DOI: 10.1002/clc.23798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/23/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background Despite evidence of the comparative benefits of transradial access percutaneous coronary intervention (PCI) over transfemoral access, its uptake remains highly varied across Australia. Few studies have explored the implications of the choice of access site during PCI from the perspective of the Australian healthcare setting. We, therefore, performed a cost‐effectiveness analysis of radial versus femoral access PCI. Methods Data from the Victorian Cardiac Outcomes Registry (VCOR) were used to inform our economic analyses. Patients treated through either radial or femoral access PCI were propensity score‐matched using the inverse probability weighted (IPW) method, and the incidence of major bleeding and all‐cause mortality in the cohort was used to inform an economic model comprising a hypothetical sample of 1000 patients. Costs and utility data were drawn from published sources. The economic evaluation adopted the perspective of the Australian healthcare system. Results Among a cohort of 1000 patients over 1 year, there were 19 fewer deaths, and six fewer episodes of nonfatal major bleeding in the radial group compared to the femoral group. Total cost savings attributed to radial access was AUD $1 214 688. Hence, from a health economic point of view, radial access PCI was dominant over femoral access PCI. Sensitivity analyses supported the robustness of these findings. Conclusions Radial access is associated with improved patient outcomes and considerably lower costs relative to femoral access PCI. Our findings support radial access being the preferred approach for PCI across a variety of indications in Australia.
Collapse
Affiliation(s)
- Peter Lee
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Cardiology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Ella Zomer
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ken Chin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Lee P, Brennan AL, Stub D, Dinh DT, Lefkovits J, Reid CM, Zomer E, Liew D. Estimating the economic impacts of percutaneous coronary intervention in Australia: a registry-based cost burden study. BMJ Open 2021; 11:e053305. [PMID: 34876433 PMCID: PMC8655558 DOI: 10.1136/bmjopen-2021-053305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES In this study, we sought to evaluate the costs of percutaneous coronary intervention (PCI) across a variety of indications in Victoria, Australia, using a direct per-person approach, as well as to identify key cost drivers. DESIGN A cost-burden study of PCI in Victoria was conducted from the Australian healthcare system perspective. SETTING A linked dataset of patients admitted to public hospitals for PCI in Victoria was drawn from the Victorian Cardiac Outcomes Registry (VCOR) and the Victorian Admitted Episodes Dataset. Generalised linear regression modelling was used to evaluate key cost drivers. From 2014 to 2017, 20 345 consecutive PCIs undertaken in Victorian public hospitals were captured in VCOR. PRIMARY OUTCOME MEASURES Direct healthcare costs attributed to PCI, estimated using a casemix funding method. RESULTS Key cost drivers identified in the cost model included procedural complexity, patient length of stay and vascular access site. Although the total procedural cost increased from $A55 569 740 in 2014 to $A72 179 656 in 2017, mean procedural costs remained stable over time ($A12 521 in 2014 to $A12 185 in 2017) after adjustment for confounding factors. Mean procedural costs were also stable across patient indications for PCI ($A9872 for unstable angina to $A15 930 for ST-elevation myocardial infarction) after adjustment for confounding factors. CONCLUSIONS The overall cost burden attributed to PCIs in Victoria is rising over time. However, despite increasing procedural complexity, mean procedural costs remained stable over time which may be, in part, attributed to changes in clinical practice.
Collapse
Affiliation(s)
- Peter Lee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Curtin University, Perth, Western Australia, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Sarkies MN, Robinson S, Briffa T, Duffy SJ, Nelson M, Beltrame J, Cullen L, Chew D, Smith J, Brieger D, Macdonald P, Liew D, Reid C. Applying a framework to assess the impact of cardiovascular outcomes improvement research. Health Res Policy Syst 2021; 19:67. [PMID: 33882947 PMCID: PMC8059028 DOI: 10.1186/s12961-021-00710-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 03/21/2021] [Indexed: 01/06/2023] Open
Abstract
Background Health and medical research funding agencies are increasingly interested in measuring the impact of funded research. We present a research impact case study for the first four years of an Australian National Health and Medical Research Council funded Centre of Research Excellence in Cardiovascular Outcomes Improvement (2016–2020). The primary aim of this paper was to explore the application of a research impact matrix to assess the impact of cardiovascular outcomes improvement research. Methods We applied a research impact matrix developed from a systematic review of existing methodological frameworks used to measure research impact. This impact matrix was used as a bespoke tool to identify and understand various research impacts over different time frames. Data sources included a review of existing internal documentation from the research centre and publicly available information sources, informal iterative discussions with 10 centre investigators, and confirmation of information from centre grant and scholarship recipients. Results By July 2019, the impact on the short-term research domain category included over 41 direct publications, which were cited over 87 times (median journal impact factor of 2.84). There were over 61 conference presentations, seven PhD candidacies, five new academic collaborations, and six new database linkages conducted. The impact on the mid-term research domain category involved contributions towards the development of a national cardiac registry, cardiovascular guidelines, application for a Medicare Benefits Schedule reimbursement item number, introduction of patient-reported outcome measures into several databases, and the establishment of nine new industry collaborations. Evidence of long-term impacts were described as the development and use of contemporary management for aortic stenosis, a cardiovascular risk prediction model and prevention targets in several data registries, and the establishment of cost-effectiveness for stenting compared to surgery. Conclusions We considered the research impact matrix a feasible tool to identify evidence of academic and policy impact in the short- to midterm; however, we experienced challenges in capturing long-term impacts. Cost containment and broader economic impacts represented another difficult area of impact to measure. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00710-4.
Collapse
Affiliation(s)
- Mitchell N Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Road, Sydney, NSW, 2109, Australia. .,Health Systems and Health Economics Group, Health Research and Data Analytics Hub, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
| | - Suzanne Robinson
- Health Systems and Health Economics Group, Health Research and Data Analytics Hub, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Tom Briffa
- Faculty of Health and Medical Sciences, Population and Public Health, The University of Western Australia, Perth, Australia
| | - Stephen J Duffy
- Department of General Cardiology, Alfred Health, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - John Beltrame
- Discipline of Medicine, University of Adelaide, Adelaide, Australia.,Cardiology Department, Central Adelaide Local Health Network, Adelaide, Australia.,Cardiology Department, Lyell McEwin Hospital, Adelaide, Australia
| | - Louise Cullen
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Derek Chew
- Department of Cardiovascular Medicine, Flinders University, Adelaide, Adelaide, Australia
| | - Julian Smith
- Department of Surgery (School of Clinical Sciences At Monash Health), Monash University, Melbourne, Australia.,Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
| | - David Brieger
- Division of Cardiology, Concord Hospital and University of Sydney, Sydney, Australia
| | - Peter Macdonald
- St Vincent's Hospital, Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia
| | - Danny Liew
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Chris Reid
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,NHMRC Centre for Research Excellence in Cardiovascular Outcomes Improvement, Health Research and Data Analytics Hub, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| |
Collapse
|