Adam C. Salisbury, M.D., FSCAI
,
Saint Lukes Mid America Heart Institute, Parkville, MO
Dimitrios Karmpaliotis, M.D.
,
Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY
J. Aaron Grantham, M.D., FSCAI
,
St. Luke's Hospital, Kansas City, MO
James Sapontis, M.D.
,
Monash Heart, Melbourne, Australia
Qingrui Meng, M.S.
,
Saint Lukes Mid America Heart Institute, Parkville, MO
Elizabeth A Magnuson, Sc.D.
,
Saint Lukes Mid America Heart Institute, Parkville, MO
Hemal Gada, M.D.
,
Pinnacle Health Cardiovascular Institute, Wormleysburg, PA
William L. Lombardi, M.D., FSCAI
,
University of Washington Medical Center, Seattle, WA
Jeffrey W. Moses, M.D., FSCAI
,
Columbia University Medical Center, New York, NY
Haiyan Li, M.S.
,
Saint Lukes Mid America Heart Institute, Parkville, MO
Suzanne V Arnold, M.D., M.H.A
,
Saint Lukes Mid America Heart Institute, Parkville, MO
Suzanne J. Baron, M.D.
,
Saint Luke's Mid America Heart Institute, Kansas City, MO
John A. Spertus, M.D.
,
Saint Lukes Mid America Heart Institute, Parkville, MO
David J Cohen, M.D.
,
Saint Luke's Mid America Heart Institute, Kansas City, MO
Background:
The cost of chronic total occlusion (CTO) PCI is generally higher than the cost to treat arteries that are not chronically occluded. Although hospital reimbursements for CTO PCI are also higher, limited data are available to describe the net economic benefit of contemporary CTO PCI from the hospital perspective.
Methods:
Among 818 patients with economic data from the 12-center OPEN CTO registry, costs of the CTO PCI hospitalization were determined from the hospital perspective using a combination of resource-based accounting (for procedural costs) and hospital billing data (for non-procedural costs). For non-procedural care (hospital days, drugs, laboratory testing, etc.) costs were calculated by multiplying nonprocedural charges by the cost-center specific cost-to-charge ratio obtained from each hospital’s Medicare cost report. Hospital reimbursement for each procedure was estimated as median hospital-specific Medicare reimbursement for DRG 246 in 2014. Contribution margin for each patient was calculated by subtracting the total hospital cost for each patient from these site-specific reimbursement rates. Confidence intervals were obtained by bootstrap replication (1000 samples).
Results:
For the overall study population the mean hospital cost of CTO PCI hospitalization was $17,048 ± $9,904, with a mean contribution margin of $7289 ± $10,151 (95% CI $6497 to $8004). When the analysis was restricted to Medicare eligible patients (n=430), the contribution margin was $6164 ± $10,922 (95% CI $5018 to $7147). Finally, when we assumed that hospital payments for patients aged <65 were 1.5x Medicare payment rates, the overall contribution margin increased to $12,842 ± $12,754 (95% CI $11,892 - $13,729).
Conclusions:
Although CTO PCI consumes more resources and is more costly than non-CTO PCI, higher procedural costs were offset by higher reimbursement rates, resulting in a favorable net “contribution margin” for CTO PCI for experienced US hospitals.
