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, Rémon 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, José 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 V. 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 journalArticleAcademicpeer-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: (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.

Original languageEnglish
Article numbere022238
JournalJournal of the American Heart Association
Volume11
Issue number5
DOIs
Publication statusPublished - 1 Mar 2022

Bibliographical note

Funding Information:
This work was supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik, and AstraZeneca.

Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc.

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