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TCT Bajaj
1. Impact of anti-thrombin therapy on hospital cost and length of stay in adult patients undergoing angioplastyRetrospective analysis of the Premier Perspective Database Neeraj R. Bajaj 1, Weihong Fan 2, Howard A. Cohen 1 , Kirk N. Garratt 1 1. Lenox Hill Hospital 2. The Medicines Company
6. The economic impact of BIV or unfractionated heparin/enoxaparin (HEP) use during PCI, with or without glycoprotein IIb/IIIa inhibitor (GPI), in unselected patients, is less certain.
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8. The database contains standard data elements available in hospital discharge files. Diagnoses and procedures are categorized according to the International Classification of Diseases, Ninth Revision (ICD-9), and Current Procedural Terminology (CPT) codes.
9. Data routinely undergo quality and completeness checks (data verification, reconciliation, and validation) as well as checks on clinical resource consumptions, manual data audit, and a warehouse audit. 5
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12. Treatment decisions were based on physician preference and individual hospital standards of care and policy. Multivariate analysis (MVA) was used to adjust for confounding patient and hospital covariates and bleeding complications.
13. Linear regression models of LOS, actual cost of hospitalization, and natural log transform of cost were developed. Covariates included: patient demographics, admission year, diagnosis (STEMI, non-STEMI, unstable angina, stable angina, chronic ischemic heart disease(CIHD)), insurance payor, hospital characteristics (region, rural/urban, teaching status, and bed size), patient co-morbidities, concomitant medication use, procedural information, and bleeding complications.
20. Results Note: This analysis was conducted based on N = 425,145 non-bleeding patients.
21. Results Note: This analysis was based on N = 26,899 bleeding patients. Due to the smaller number of patients, the MVA of natural log transformation of cost is presented only.
24. After adjustment for covariates, BIV monotherapy was associated with significantly lower costs ($1116 less) and shorter LOS after PCI (0.276 days less) when compared with HEP+GPI.