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 Heijden; Bert 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

doi:10.1161/JAHA.121.022238

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 journal › Article › Academic › peer-review

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 language	English
Article number	e022238
Journal	Journal of the American Heart Association
Volume	11
Issue number	5
DOIs	https://doi.org/10.1161/JAHA.121.022238
Publication status	Published - 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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Camaro, C., Bonnes, J. L., Adang, E. M., Spoormans, E. M., Janssens, G. N., van der Hoeven, N. W., Jewbali, L. S., Dubois, E. A., Meuwissen, M., Rijpstra, T. A., Bosker, H. A., Blans, M. J., Bleeker, G. B., Baak, R., Vlachojannis, G. J., Eikemans, B. J., van der Harst, P., van der Horst, I. C., Voskuil, M., ... van Royen, N. (2022). Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest. Journal of the American Heart Association, 11(5), [e022238]. https://doi.org/10.1161/JAHA.121.022238

@article{c1b078106944420dad78c9e3447f1dcb,

title = "Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest",

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.",

author = "Cyril Camaro and Bonnes, {Judith L.} and Adang, {Eddy M.} and Spoormans, {Eva M.} and Janssens, {Gladys N.} and {van der Hoeven}, {Nina W.} and Jewbali, {Lucia S.} and Dubois, {Eric A.} and Martijn Meuwissen and Rijpstra, {Tom A.} and Bosker, {Hans A.} and Blans, {Michiel J.} and Bleeker, {Gabe B.} and R{\'e}mon Baak and Vlachojannis, {George J.} and Eikemans, {Bob J.} and {van der Harst}, Pim and {van der Horst}, {Iwan C.} and Michiel Voskuil and {van der Heijden}, {Joris J.} and Bert Beishuizen and Martin Stoel and {van der Hoeven}, Hans and Henriques, {Jos{\'e} P.} and Vlaar, {Alexander P.} and Vink, {Maarten A.} and {van den Bogaard}, Bas and Heestermans, {Ton A.} and {de Ruijter}, Wouter and Delnoij, {Thijs S.} and Crijns, {Harry J.} and Jessurun, {Gillian A.} and Oemrawsingh, {Pranobe V.} and Gosselink, {Marcel T.} and Koos Plomp and Michael Magro and Elbers, {Paul W.} and {van de Ven}, {Peter M.} and Lemkes, {Jorrit S.} and {van Royen}, Niels",

note = "Funding Information: This work was supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik, and AstraZeneca. Publisher Copyright: {\textcopyright} 2022 The Authors. Published on behalf of the American Heart Association, Inc.",

year = "2022",

month = mar,

day = "1",

doi = "10.1161/JAHA.121.022238",

language = "English",

volume = "11",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "5",

}

Camaro, C, Bonnes, JL, Adang, EM, Spoormans, EM, Janssens, GN, van der Hoeven, NW, Jewbali, LS , Dubois, EA, Meuwissen, M, Rijpstra, TA, Bosker, HA, Blans, MJ, Bleeker, GB, Baak, R, Vlachojannis, GJ, Eikemans, BJ, van der Harst, P, van der Horst, IC, Voskuil, M, van der Heijden, JJ, Beishuizen, B, Stoel, M, van der Hoeven, H, Henriques, JP, Vlaar, AP, Vink, MA, van den Bogaard, B, Heestermans, TA, de Ruijter, W, Delnoij, TS, Crijns, HJ, Jessurun, GA, Oemrawsingh, PV, Gosselink, MT, Plomp, K, Magro, M, Elbers, PW, van de Ven, PM, Lemkes, JS & van Royen, N 2022, 'Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest', Journal of the American Heart Association, vol. 11, no. 5, e022238. https://doi.org/10.1161/JAHA.121.022238

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, Rémon

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, José 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 V.

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

N1 - 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.

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: (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.

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: (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.

UR - http://www.scopus.com/inward/record.url?scp=85125554393&partnerID=8YFLogxK

U2 - 10.1161/JAHA.121.022238

DO - 10.1161/JAHA.121.022238

M3 - Article

C2 - 35195012

AN - SCOPUS:85125554393

SN - 2047-9980

VL - 11

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 5

M1 - e022238

ER -

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

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