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 -