[Evaluation of the economic impact and the patient pathway in the treatment of chronic total occlusion].

IF 1 Q4 PHARMACOLOGY & PHARMACY Annales pharmaceutiques francaises Pub Date : 2024-10-24 DOI:10.1016/j.pharma.2024.10.006
Lucas Delporte, Marie-Caroline Brianceau, Emir Kaïs Rihani, Morgane Masse, Claire Lauerière, Pascal Odou, Cédric Delhaye, Bertrand Décaudin
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引用次数: 0

Abstract

Objectives: Chronic total occlusion (CTO) of coronary arteries is defined as complete absence of antegrade coronary flow without iodine passage, since more than 3 months. Coronary revascularization is a highly resource-intensive angioplasty procedure involving numerous medical devices (MDs). Its consumption and associated costs are not covered by either the medical act classification (CCAM) or the hospitalization fees and additional MD funding. The primary aim of this study is to analyze the financial sustainability of this activity for a public healthcare institution and to assess the budgetary impact of CTO treatment on the most expensive items of expenditure. The secondary aim is to describe the patient's intra-hospital pathway.

Methods: CTO revascularization stays are categorized under the code 05K06 "Vascular Stents without Myocardial Infarction". Major cost items were identified using national coded expenditure data and compared with those from our cost study. Every CTO intervention from January to November 2021 were retrospectively retrieved. Establishment purchase prices in 2021 were used to determine MD costs. Clinical data were extracted from electronic patient records. Operative data (procedure duration, professionals involved, and MD used) were extracted. Human Resources (HR) costs were integrated into the calculations. A Sankey diagram was created. Data are expressed as mean±standard deviation.

Results: In our study, 41 patients underwent 45 interventions. The median was 65 years. Seventy-eight percent of interventions were successful with a median duration of 113minutes. Two hundred and two different MD references were used, with 27% reimbursed additionally and 73% funded within the homogeneous group of stays (HGS). The total cost of MD described in the coded expenditure data is 2142€, of which 721€ is funded within the HGS. In our cohort, it represented averages of 2736€±1393€ and 1710€±926€, respectively. Regarding HR, the total cost described in the coded expenditure data was 442€ compared to 410€±169€ in our cohort. Finally, patient pathway analysis showed an average length of stay (LOS) of 1.8 days. Two pathways were identified depending on admission context: weekday hospitalization or cardiac intensive care.

Conclusions: CTO revascularization is a planned intervention with a short LOS and a highly standardized patient pathway. Our study highlights a proliferation of MD references used during CTO revascularization due to innovative industrial developments. The cost differential with coded expenditure data confirms the need for a revision of the procedure and its categorization within an HGS, which is currently non-specific.

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[评估治疗慢性全闭塞症的经济影响和患者路径]。
目的:冠状动脉慢性全闭塞(CTO)的定义是,冠状动脉前向血流完全断流且无碘通过,时间超过 3 个月。冠状动脉血运重建是一种高度资源密集型血管成形术,涉及大量医疗设备(MD)。无论是医疗行为分类(CCAM)还是住院费和额外的 MD 经费都不包括其消耗和相关费用。本研究的主要目的是分析这一活动对一家公共医疗机构的财务可持续性,并评估 CTO 治疗对最昂贵支出项目的预算影响。次要目的是描述患者的院内治疗路径:方法:CTO 血管再通术的住院时间归类于代码 05K06 "无心肌梗死的血管支架"。利用全国编码支出数据确定主要成本项目,并与我们的成本研究进行比较。回顾性检索了 2021 年 1 月至 11 月的每次 CTO 介入治疗。2021 年的机构采购价格用于确定 MD 成本。临床数据提取自电子病历。提取手术数据(手术时间、参与的专业人员和使用的 MD)。人力资源(HR)成本纳入计算。绘制了桑基图。数据以平均值 ± 标准差表示:在我们的研究中,41 名患者接受了 45 次干预。中位数为 65 岁。78%的介入治疗成功,中位持续时间为 113 分钟。使用了 222 种不同的 MD 参考资料,其中 27% 获得额外报销,73% 在同质住院组(HGS)内获得资助。编码支出数据中描述的 MD 总成本为 2142 欧元,其中 721 欧元由 HGS 资助。在我们的队列中,其平均值分别为 2736 欧元 ± 1393 欧元和 1710 欧元 ± 926 欧元。在人力资源方面,编码支出数据中描述的总费用为 442 欧元,而在我们的队列中为 410 欧元 ± 169 欧元。最后,患者路径分析显示平均住院时间(LOS)为 1.8 天。根据入院情况确定了两种路径:工作日住院或心脏重症监护:结论:CTO血管重建术是一种有计划的介入治疗,住院时间短,患者路径高度标准化。我们的研究突出表明,由于工业的创新发展,CTO 血管再通术中使用的 MD 参考资料越来越多。编码支出数据的成本差异证实,有必要对该手术及其在 HGS 中的分类进行修订,因为目前的分类还不具体。
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来源期刊
Annales pharmaceutiques francaises
Annales pharmaceutiques francaises PHARMACOLOGY & PHARMACY-
CiteScore
1.70
自引率
7.70%
发文量
98
期刊介绍: This journal proposes a scientific information validated and indexed to be informed about the last research works in all the domains interesting the pharmacy. The original works, general reviews, the focusing, the brief notes, subjected by the best academics and the professionals, propose a synthetic approach of the last progress accomplished in the concerned sectors. The thematic Sessions and the – life of the Academy – resume the communications which, presented in front of the national Academy of pharmacy, are in the heart of the current events.
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[Automated dispensing cabinet: an evaluation of professional practices that says much more than what the authors write.] Advanced stability-indicating RP-HPLC method for the quantification of Lurasidone Hydrochloride in bulk and PLGA based in-situ implant formulation. Factors Associated with Therapeutic Non-Adherence in Asthmatic Patients: A Multicenter Study in Algeria. Self-medication of the pediatric population by parents in Morocco: Survey in the Midelt region. [Evaluation of the economic impact and the patient pathway in the treatment of chronic total occlusion].
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