バックアップ手術の有無による血管形成術のコストの比較（LBCT- 20035）

C-PORT-E：非緊急血管形成術のコストはバックアップ手術のない病院の方が高い

C-PORT-E: Non-emergency angioplasty costs higher in hospitals without back-up surgery

血管形成術のコストは緊急時バックアップ心臓手術体制のない病院において、その体制のある病院と比較し高かった、とのLate-Breaking Clinical Trialの結果が2012年American Heart Association学会で発表された。Cardiovascular Patient Outcomes Research Outcomes of Percutaneous Team（C-PORT-E）トライアルにおいて、心臓手術体制のない病院で施行される待機的血管形成術の安全性および有効性は、院内で心臓手術のできる病院で行われる場合と同等であることが示された。この結果は、心臓外科のない病院がこの施術を同等のコストで行い得るかに焦点をシフトさせた。研究者らは米国59の病院で治療された患者18,273人（平均年齢64歳、白人79%、男性63%）の請求書のデータを解析した。治療9か月後の平均累積医療費は心臓手術体制を有する病院で$23,991であったのに対し、心臓手術体制のない病院では$25,460であった。この差には2つの因子が影響していた―スタディプロトコールでは心臓手術体制のない病院では血管形成術後管理に集中治療室を使用することを求めたこと、およびこれらの病院で治療を受けた患者は心臓手術体制を有する病院で血管形成術を受けた患者よりも治療9か月後の再入院率が高かったことであった。

Angioplasty costs were higher in hospitals not equipped with emergency back-up heart surgery, compared to those hospitals that are, according to late-breaking clinical trial research presented at the American Heart Association's Scientific Sessions 2012.

The Cardiovascular Patient Outcomes Research Outcomes of Percutaneous Team (C-PORT-E) clinical trial found that elective angioplasty performed in hospitals without heart surgery capabilities had similar safety and efficacy as those performed at hospitals with on-site cardiac surgery. That finding shifted the focus to whether non-surgery hospitals can perform these procedures at a similar cost.

Increasingly, hospitals without on-site cardiac surgery are opting to offer elective angioplasty in house, rather than transferring patients to hospitals with surgical back up. To compare cost-effectiveness, this first large, multi-center study of its kind analyzed the expenses associated with non-emergency angioplasty in hospitals with and without cardiac surgery.

Investigators analyzed billing data from 18,273 patients (average age 64, 79 percent white and 63 percent male) treated in 59 hospitals in 10 states.

Nine months after treatment, investigators found that average cumulative medical costs were $23,991 in surgery-equipped hospitals, versus $25,460 in non-surgery hospitals. Two factors contributed to this difference — the study protocol required non-surgery hospitals to use intensive care units for post-angioplasty care and patients treated at these hospitals were more likely than those receiving angioplasty at cardiac equipped hospitals to be readmitted nine months after treatment.

"Our findings have relevance for healthcare policymakers and providers," said Eric L. Eisenstein, D.B.A., lead author of the study and assistant professor of medicine, and community and family medicine at Duke University School of Medicine in Durham, N.C. "These results should provide caution for hospitals without cardiac surgery back-up considering the implementation of non-primary, or non-emergency, angioplasty services. There is no guarantee that a community hospital can provide angioplasty services at costs comparable with those of major hospitals with on-site cardiac surgery."

Co-authors include Linda Davidson-Ray, M.A.; Rex Edwards; Kevin J. Anstrom, Ph.D.; Patricia A. Cowper, Ph.D.; Daniel B. Mark, M.D., M.P.H.; and Thomas R. Aversano, M.D.

John Hopkins University funded the study through a research grant to Duke University Medical Center.