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TCT Bajaj
- 1. Impact of anti-thrombin therapy on hospital cost and length of stay in adult patients undergoing angioplastyRetrospective analysis of the Premier Perspective Database Neeraj R. Bajaj 1, Weihong Fan 2, Howard A. Cohen 1 , Kirk N. Garratt 1 1. Lenox Hill Hospital 2. The Medicines Company
- 3. Weihong Fan receives salary support from The Medicines Company.
- 4. Howard A. Cohen has no conflicts to disclose.
- 6. The economic impact of BIV or unfractionated heparin/enoxaparin (HEP) use during PCI, with or without glycoprotein IIb/IIIa inhibitor (GPI), in unselected patients, is less certain.
- 8. The database contains standard data elements available in hospital discharge files. Diagnoses and procedures are categorized according to the International Classification of Diseases, Ninth Revision (ICD-9), and Current Procedural Terminology (CPT) codes.
- 9. Data routinely undergo quality and completeness checks (data verification, reconciliation, and validation) as well as checks on clinical resource consumptions, manual data audit, and a warehouse audit. 5
- 12. Treatment decisions were based on physician preference and individual hospital standards of care and policy. Multivariate analysis (MVA) was used to adjust for confounding patient and hospital covariates and bleeding complications.
- 13. Linear regression models of LOS, actual cost of hospitalization, and natural log transform of cost were developed. Covariates included: patient demographics, admission year, diagnosis (STEMI, non-STEMI, unstable angina, stable angina, chronic ischemic heart disease(CIHD)), insurance payor, hospital characteristics (region, rural/urban, teaching status, and bed size), patient co-morbidities, concomitant medication use, procedural information, and bleeding complications.
- 15. Results Note: All comparisons are 4-way. All P-values are <0.0001
- 16. Results Note: All comparisons are 4-way. All P-values are <0.0001
- 17. Results Note: All comparisons are 4-way. All P-values are <0.0001
- 18. Results Note: All comparisons are 4-way. All P-values are <0.0001
- 19. Results
- 20. Results Note: This analysis was conducted based on N = 425,145 non-bleeding patients.
- 21. Results Note: This analysis was based on N = 26,899 bleeding patients. Due to the smaller number of patients, the MVA of natural log transformation of cost is presented only.
- 23. Univariate analysis indicated BIV monotherapy was associated with lower costs and shorter LOS after PCI.
- 24. After adjustment for covariates, BIV monotherapy was associated with significantly lower costs ($1116 less) and shorter LOS after PCI (0.276 days less) when compared with HEP+GPI.
- 26. Inherent limitations of registry data and data collection.
- 27. Exclusion of significant number of PCI patients (22.5%) without a record of treatment of either bivalirudin ± GPI or heparins ± GPI.