Cost-effectiveness of Primary Pci at Hospitals without Onsite Cabg

A myocardial infarction (MI) occurs when blood supply to the heart is cut off by a blockage in one of the coronary arteries. Most hospitals treat a patient with thrombolysis or a percutaneous coronary intervention (PCI). The latter has been established as the preferred revascularization method. However, the American College of Cardiologists and the American Heart Association strongly recommend that a hospital performing PCI must also have coronary artery bypass graft capabilities (CABG). By following these recommendations, the state of Kentucky has limited the number of hospitals allowed to perform PCI and thereby limiting access to such a life-saving procedure. Recently, the state of Kentucky evaluated if hospitals without such capabilities should be allowed to perform primary PCI, and the resulting data allowed the establishment of the medical soundness of allowing such hospitals to perform primary PCI. The current study aims to evaluate the financial feasibility of allowing these hospitals to do emergency PCI in addition to hospitals with onsite open-heart surgery capabilities. Estimates have been derived from a systematic literature review of national studies based on PCI registries as well as our earlier study KENTUCKY PILOT PROJECT FOR PRIMARY PCI WITHOUT ONSITE CABG. Costs estimates were derived from the National Inpatient Sample, which approximates a twenty percent sample of the U.S. community hospitals. In determining costs, the observations were extracted by filtering using ICD-9 codes. A deterministic model was developed so that more uncertainty would not be introduced. The economic evaluation focused on estimating the incremental cost effectiveness ratio (ICER) of allowing regional hospitals to perform primary PCI from a payer’s perspective. Uncertainty about the model parameters was investigated through sensitivity analysis techniques. The study found that there were no statistically significant differences in outcomes between hospitals with and without CABG capabilities. The only characteristic, which was significantly different between these two groups, was total charges. The alternative to allow Regional Hospitals as well to perform primary PCI dominated the other alternative of Only Allowing Hospitals with Onsite CABG to perform PCI. The study suggests that by allowing primary PCI to be performed at selected facilities without onsite CABG, the state of Kentucky can expand access to PCI and reduce geographical health disparities, one of its main healthcare initiatives.