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Randomized Controlled Trial
. 2022 Mar;11(5):e022238.
doi: 10.1161/JAHA.121.022238. Epub 2022 Feb 23.

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

Cyril Camaro  1 , Judith L Bonnes  1 , Eddy M Adang  2 , Eva M Spoormans  3 , Gladys N Janssens  3 , Nina W van der Hoeven  3 , Lucia S Jewbali  4 , Eric A Dubois  4 , Martijn Meuwissen  5 , Tom A Rijpstra  6 , Hans A Bosker  7 , Michiel J Blans  8 , Gabe B Bleeker  9 , Rémon Baak  10 , George J Vlachojannis  11 , Bob J Eikemans  12 , Pim van der Harst  13 , Iwan C van der Horst  14   15 , Michiel Voskuil  16 , Joris J van der Heijden  17 , Bert Beishuizen  18 , Martin Stoel  19 , Hans van der Hoeven  20 , José P Henriques  21 , Alexander P Vlaar  22 , Maarten A Vink  23 , Bas van den Bogaard  24 , Ton A Heestermans  25 , Wouter de Ruijter  26 , Thijs S Delnoij  15   27 , Harry J Crijns  27 , Gillian A Jessurun  28 , Pranobe V Oemrawsingh  29 , Marcel T Gosselink  30 , Koos Plomp  31 , Michael Magro  32 , Paul W Elbers  33 , Peter M van de Ven  34 , Jorrit S Lemkes  3 , Niels van Royen  1   3
Affiliations
Randomized Controlled Trial

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

Cyril Camaro et al. J Am Heart Assoc. 2022 Mar.

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: (β, 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<0.001). Costs concerning intensive care unit and ward stay did not show any significant difference. The RAND-36 questionnaire did not differ between both groups. 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.

Keywords: coronary angiography; health care costs; non–ST‐segment–elevation myocardial infarction; out‐of‐hospital cardiac arrest.

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Figures

Figure. 1
Figure. 1. Cost drivers and total costs in EURO by group.
Box plots of procedure costs, intensive care unit costs, ward costs, and total costs between the immediate and delayed angiography group. IC indicates intensive care.
See this image and copyright information in PMC

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