Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest

Cyril Camaro; Judith L. Bonnes; Eddy M. Adang; Eva M. Spoormans; Gladys N. Janssens; Nina W. van der Hoeven; Lucia S. Jewbali; Eric A. Dubois; Martijn Meuwissen; Tom A. Rijpstra; Hans A. Bosker; Michiel J. Blans; Gabe B. Bleeker; Remon Baak; George J. Vlachojannis; Bob J. Eikemans; Pim van der Harst; Iwan C. van der Horst; Michiel Voskuil; Joris J. van der Heijden; Bert Beishuizen; Martin Stoel; Hans van der Hoeven; Jose P. Henriques; Alexander P. Vlaar; Maarten A. Vink; Bas van den Bogaard; Ton A. Heestermans; Wouter de Ruijter; Thijs S. Delnoij; Harry J. Crijns; Gillian A. Jessurun; Pranobe Oemrawsingh; Marcel T. Gosselink; Koos Plomp; Michael Magro; Paul W. Elbers; Peter M. van de Ven; Jorrit S. Lemkes; Niels van Royen

doi:10.1161/JAHA.121.022238

Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest

Cyril Camaro, Judith L. Bonnes, Eddy M. Adang, Eva M. Spoormans, Gladys N. Janssens, Nina W. van der Hoeven, Lucia S. Jewbali, Eric A. Dubois, Martijn Meuwissen, Tom A. Rijpstra, Hans A. Bosker, Michiel J. Blans, Gabe B. Bleeker, Remon Baak, George J. Vlachojannis, Bob J. Eikemans, Pim van der Harst, Iwan C. van der Horst, Michiel Voskuil, Joris J. van der HeijdenBert Beishuizen, Martin Stoel, Hans van der Hoeven, Jose P. Henriques, Alexander P. Vlaar, Maarten A. Vink, Bas van den Bogaard, Ton A. Heestermans, Wouter de Ruijter, Thijs S. Delnoij, Harry J. Crijns, Gillian A. Jessurun, Pranobe Oemrawsingh, Marcel T. Gosselink, Koos Plomp, Michael Magro, Paul W. Elbers, Peter M. van de Ven, Jorrit S. Lemkes, Niels van Royen^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND In patients with out-of-hospital cardiac arrest without ST-segment elevation, immediate coronary angiography did not improve clinical outcomes when compared with delayed angiography in the COACT (Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2 strategies has benefits in terms of health care resource use and costs is currently unknown. We assess the health care resource use and costs in patients with out-of-hospital cardiac arrest.

METHODS AND RESULTS A total of 538 patients were randomly assigned to a strategy of either immediate or delayed coronary angiography. Detailed health care resource use and cost-prices were collected from the initial hospital episode. A generalized linear model and a gamma distribution were performed. Generic quality of life was measured with the RAND-36 and collected at 12-month follow-up. Overall total mean costs were similar between both groups (EUR 33 575 +/- 19 612 versus EUR 33 880 +/- 21 044; P=0.86). Generalized linear model: (beta, 0.991; 95% CI, 0.894-1.099; P=0.86). Mean procedural costs (coronary angiography and percutaneous coronary intervention, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384 +/- 3447 versus EUR 3028 +/- 4220; P

CONCLUSIONS The mean total costs between patients with out-of-hospital cardiac arrest randomly assigned to an immediate angiography or a delayed invasive strategy were similar during the initial hospital stay. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered.

REGISTRATION

URL: https://trialregister.nl; Unique identifier: NL4857.

Original language	English
Article number	022238
Number of pages	17
Journal	Journal of the American Heart Association
Volume	11
Issue number	5
DOIs	https://doi.org/10.1161/JAHA.121.022238
Publication status	Published - 1-Mar-2022

Keywords

coronary angiography
health care costs
non-ST-segment-elevation myocardial infarction
out-of-hospital cardiac arrest
ST-SEGMENT ELEVATION
CORONARY-ANGIOGRAPHY
DESIGN
RATIONALE
STRATEGY
CONSENSUS

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Camaro, C., Bonnes, J. L., Adang, E. M., Spoormans, E. M., Janssens, G. N., van der Hoeven, N. W., Jewbali, L. S., Dubois, E. A., Meuwissen, M., Rijpstra, T. A., Bosker, H. A., Blans, M. J., Bleeker, G. B., Baak, R., Vlachojannis, G. J., Eikemans, B. J., van der Harst, P., van der Horst, I. C., Voskuil, M., ... van Royen, N. (2022). Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest. Journal of the American Heart Association, 11(5), Article 022238. https://doi.org/10.1161/JAHA.121.022238

@article{cc606a4c2b10416c81ba434b9714dceb,

title = "Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest",

abstract = "BACKGROUND In patients with out-of-hospital cardiac arrest without ST-segment elevation, immediate coronary angiography did not improve clinical outcomes when compared with delayed angiography in the COACT (Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2 strategies has benefits in terms of health care resource use and costs is currently unknown. We assess the health care resource use and costs in patients with out-of-hospital cardiac arrest.METHODS AND RESULTS A total of 538 patients were randomly assigned to a strategy of either immediate or delayed coronary angiography. Detailed health care resource use and cost-prices were collected from the initial hospital episode. A generalized linear model and a gamma distribution were performed. Generic quality of life was measured with the RAND-36 and collected at 12-month follow-up. Overall total mean costs were similar between both groups (EUR 33 575 +/- 19 612 versus EUR 33 880 +/- 21 044; P=0.86). Generalized linear model: (beta, 0.991; 95% CI, 0.894-1.099; P=0.86). Mean procedural costs (coronary angiography and percutaneous coronary intervention, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384 +/- 3447 versus EUR 3028 +/- 4220; PCONCLUSIONS The mean total costs between patients with out-of-hospital cardiac arrest randomly assigned to an immediate angiography or a delayed invasive strategy were similar during the initial hospital stay. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered.REGISTRATIONURL: https://trialregister.nl; Unique identifier: NL4857.",

keywords = "coronary angiography, health care costs, non-ST-segment-elevation myocardial infarction, out-of-hospital cardiac arrest, ST-SEGMENT ELEVATION, CORONARY-ANGIOGRAPHY, DESIGN, RATIONALE, STRATEGY, CONSENSUS",

author = "Cyril Camaro and Bonnes, {Judith L.} and Adang, {Eddy M.} and Spoormans, {Eva M.} and Janssens, {Gladys N.} and {van der Hoeven}, {Nina W.} and Jewbali, {Lucia S.} and Dubois, {Eric A.} and Martijn Meuwissen and Rijpstra, {Tom A.} and Bosker, {Hans A.} and Blans, {Michiel J.} and Bleeker, {Gabe B.} and Remon Baak and Vlachojannis, {George J.} and Eikemans, {Bob J.} and {van der Harst}, Pim and {van der Horst}, {Iwan C.} and Michiel Voskuil and {van der Heijden}, {Joris J.} and Bert Beishuizen and Martin Stoel and {van der Hoeven}, Hans and Henriques, {Jose P.} and Vlaar, {Alexander P.} and Vink, {Maarten A.} and {van den Bogaard}, Bas and Heestermans, {Ton A.} and {de Ruijter}, Wouter and Delnoij, {Thijs S.} and Crijns, {Harry J.} and Jessurun, {Gillian A.} and Pranobe Oemrawsingh and Gosselink, {Marcel T.} and Koos Plomp and Michael Magro and Elbers, {Paul W.} and {van de Ven}, {Peter M.} and Lemkes, {Jorrit S.} and {van Royen}, Niels",

year = "2022",

month = mar,

day = "1",

doi = "10.1161/JAHA.121.022238",

language = "English",

volume = "11",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley",

number = "5",

}

Camaro, C, Bonnes, JL, Adang, EM, Spoormans, EM, Janssens, GN, van der Hoeven, NW, Jewbali, LS, Dubois, EA, Meuwissen, M, Rijpstra, TA, Bosker, HA, Blans, MJ, Bleeker, GB, Baak, R, Vlachojannis, GJ, Eikemans, BJ, van der Harst, P , van der Horst, IC , Voskuil, M, van der Heijden, JJ, Beishuizen, B, Stoel, M, van der Hoeven, H, Henriques, JP, Vlaar, AP, Vink, MA, van den Bogaard, B, Heestermans, TA, de Ruijter, W, Delnoij, TS, Crijns, HJ, Jessurun, GA, Oemrawsingh, P, Gosselink, MT, Plomp, K, Magro, M, Elbers, PW, van de Ven, PM, Lemkes, JS & van Royen, N 2022, 'Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest', Journal of the American Heart Association, vol. 11, no. 5, 022238. https://doi.org/10.1161/JAHA.121.022238

TY - JOUR

T1 - Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest

AU - Camaro, Cyril

AU - Bonnes, Judith L.

AU - Adang, Eddy M.

AU - Spoormans, Eva M.

AU - Janssens, Gladys N.

AU - van der Hoeven, Nina W.

AU - Jewbali, Lucia S.

AU - Dubois, Eric A.

AU - Meuwissen, Martijn

AU - Rijpstra, Tom A.

AU - Bosker, Hans A.

AU - Blans, Michiel J.

AU - Bleeker, Gabe B.

AU - Baak, Remon

AU - Vlachojannis, George J.

AU - Eikemans, Bob J.

AU - van der Harst, Pim

AU - van der Horst, Iwan C.

AU - Voskuil, Michiel

AU - van der Heijden, Joris J.

AU - Beishuizen, Bert

AU - Stoel, Martin

AU - van der Hoeven, Hans

AU - Henriques, Jose P.

AU - Vlaar, Alexander P.

AU - Vink, Maarten A.

AU - van den Bogaard, Bas

AU - Heestermans, Ton A.

AU - de Ruijter, Wouter

AU - Delnoij, Thijs S.

AU - Crijns, Harry J.

AU - Jessurun, Gillian A.

AU - Oemrawsingh, Pranobe

AU - Gosselink, Marcel T.

AU - Plomp, Koos

AU - Magro, Michael

AU - Elbers, Paul W.

AU - van de Ven, Peter M.

AU - Lemkes, Jorrit S.

AU - van Royen, Niels

PY - 2022/3/1

Y1 - 2022/3/1

N2 - BACKGROUND In patients with out-of-hospital cardiac arrest without ST-segment elevation, immediate coronary angiography did not improve clinical outcomes when compared with delayed angiography in the COACT (Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2 strategies has benefits in terms of health care resource use and costs is currently unknown. We assess the health care resource use and costs in patients with out-of-hospital cardiac arrest.METHODS AND RESULTS A total of 538 patients were randomly assigned to a strategy of either immediate or delayed coronary angiography. Detailed health care resource use and cost-prices were collected from the initial hospital episode. A generalized linear model and a gamma distribution were performed. Generic quality of life was measured with the RAND-36 and collected at 12-month follow-up. Overall total mean costs were similar between both groups (EUR 33 575 +/- 19 612 versus EUR 33 880 +/- 21 044; P=0.86). Generalized linear model: (beta, 0.991; 95% CI, 0.894-1.099; P=0.86). Mean procedural costs (coronary angiography and percutaneous coronary intervention, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384 +/- 3447 versus EUR 3028 +/- 4220; PCONCLUSIONS The mean total costs between patients with out-of-hospital cardiac arrest randomly assigned to an immediate angiography or a delayed invasive strategy were similar during the initial hospital stay. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered.REGISTRATIONURL: https://trialregister.nl; Unique identifier: NL4857.

AB - BACKGROUND In patients with out-of-hospital cardiac arrest without ST-segment elevation, immediate coronary angiography did not improve clinical outcomes when compared with delayed angiography in the COACT (Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2 strategies has benefits in terms of health care resource use and costs is currently unknown. We assess the health care resource use and costs in patients with out-of-hospital cardiac arrest.METHODS AND RESULTS A total of 538 patients were randomly assigned to a strategy of either immediate or delayed coronary angiography. Detailed health care resource use and cost-prices were collected from the initial hospital episode. A generalized linear model and a gamma distribution were performed. Generic quality of life was measured with the RAND-36 and collected at 12-month follow-up. Overall total mean costs were similar between both groups (EUR 33 575 +/- 19 612 versus EUR 33 880 +/- 21 044; P=0.86). Generalized linear model: (beta, 0.991; 95% CI, 0.894-1.099; P=0.86). Mean procedural costs (coronary angiography and percutaneous coronary intervention, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384 +/- 3447 versus EUR 3028 +/- 4220; PCONCLUSIONS The mean total costs between patients with out-of-hospital cardiac arrest randomly assigned to an immediate angiography or a delayed invasive strategy were similar during the initial hospital stay. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered.REGISTRATIONURL: https://trialregister.nl; Unique identifier: NL4857.

KW - coronary angiography

KW - health care costs

KW - non-ST-segment-elevation myocardial infarction

KW - out-of-hospital cardiac arrest

KW - ST-SEGMENT ELEVATION

KW - CORONARY-ANGIOGRAPHY

KW - DESIGN

KW - RATIONALE

KW - STRATEGY

KW - CONSENSUS

U2 - 10.1161/JAHA.121.022238

DO - 10.1161/JAHA.121.022238

M3 - Article

SN - 2047-9980

VL - 11

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 5

M1 - 022238

ER -

Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest

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Keywords

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