Short and Mid-Term Economic Impact of Pulmonary Artery Catheter Use in Adult Cardiac Surgery: A Hospital and Integrated Health System Perspective

Abstract

Mitali Stevens,1 Todd Davis,1 Sibyl H Munson,2 Apeksha V Shenoy,2 Boye LA Gricar,2 Halit O Yapici,2 Andrew D Shaw3 1Global Health Economics & Reimbursement, Edwards Lifesciences, Irvine, CA, USA; 2Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA; 3Department of Anaesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, CanadaCorrespondence: Andrew D ShawDepartment of Anaesthesiology and Pain Medicine, University of Alberta, 8440 112 St NW, Edmonton, Alberta T6G 2G3, CanadaEmail [email protected]: A monitoring pulmonary artery catheter (PAC) is utilized in approximately 34% of the US cardiac surgical procedures. Increased use of PAC has been reported to have an association with complication rates: significant decreases in new-onset heart failure (HF) and respiratory failure (RF), but increases in bacteremia and urinary tract infections. We assessed the impact of increasing PAC adoption on hospital costs among cardiac surgery patients for US-based healthcare systems.Methods: An Excel-based economic model calculated annualized savings for a US hospital with various cardiac surgical volumes and PAC adoption rates. A second model, for an integrated payer-provider health system, analyzed outcomes/costs resulting from the cardiac surgical admission and for the treatment of persistent HF and RF complications in the year following surgery. Model inputs were extracted from published literature, and one-way and probabilistic sensitivity analyses were performed.Results: For an acute care hospital with 500 procedures/year and 34% PAC adoption, annualized savings equalled $61,806 vs no PAC utilization. An increase in PAC adoption rate led to increased savings of $134,751 for 75% and $170,685 for 95% adoption. Savings ranged from $12,361 to $185,418 at volumes of 100 and 1500 procedures/year, respectively. For an integrated payer-provider health system with the base-case scenario of 3845 procedures/year and 34% PAC adoption, estimated savings were $596,637 for the combined surgical index admission and treatment for related complications over the following year.Conclusion: PAC utilization in adult cardiac surgery patients results in reduced costs for both acute care hospitals and payer-provider integrated health systems.Keywords: heart failure, respiratory failure, economic evaluation, cost analysis, acute care hospital, integrated payer-provider

Keywords

• heart failure
• respiratory failure
• economic evaluation
• cost analysis
• acute care hospital
• integrated payer-provider