Spotlight on PCI in the Value Debate: PCI costs have no correlation with mortality
JACC in a Flash | Variation in 1-year risk-adjusted mortality was much smaller compared to risk-standardized costs after percutaneous coronary intervention (PCI), according to a retrospective cohort study using data from the national Veterans Affairs’ (VA) Clinical Assessment, Report and Tracking (CART) program at 60 hospitals.
By examining both outcomes and costs simultaneously, the study authors led by P. Michael Ho, MD, Denver Veteran Affairs Medical Center, University of Colorado, Denver, framed their findings in the growing construct of health care value—getting more for what you pay. Primary outcomes were 1-year mortality and costs following PCI, which were standardized after adjusting for cardiac and noncardiac comorbidities.
Study results showed four hospitals significantly above the 1-year risk standardized median mortality rate, with median mortality ratios ranging from 1.23 to 1.28. There were no hospitals significantly below median mortality. Also of note, median 1-year total unadjusted hospital costs were $46,302 per patient. According to the authors, “There were 16 hospitals above and 19 hospitals below the risk standardized average cost, with risk standardized ratios ranging from 0.45 to 2.09, reflecting much larger magnitude of variability in costs compared to mortality.”
The study authors noted these findings highlight opportunities to improve PCI value by reducing costs without compromising outcomes. “This approach to evaluating outcomes and costs together may be a model for other health systems and accountable care organizations interested in operationalizing value measurement,” they said. That being said, future evaluation, such as qualitative research, will be needed to identify specific reasons for cost variations.
Similarly, a corresponding editorial comment by Daniel M. Alyeshmerni, MD, et al, said that “challenges aside,” the study results are “a positive step forward.” With the ongoing implementation of health care reform and an increased emphasis on new payment models, the authors wrote that “the time for moving forward with value measurement has never been more important.”
Ho PM, O’Donnell C, Bradley S, et al. J Am Coll Cardiol. 2015;65:236-42.
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