Major adverse coronary events (MACE) are a complication in cardiac caths and PCI with substantial resource utilization and costs, according to a study presented at American Heart Association’s Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Scientific Sessions in Washington D.C. last week.
According to lead author Brian Meissner, PharmD, PhD, director at managed markets agency and consultancy firm Xcenda, and colleagues, the resource utilization and costs associated with MACE are not well documented in actual clinical practice. Furthermore, they wrote, the correlation between utilizing contrast media during cardiac caths /PCI and MACE is “heavily debated” with clinical trial data showing that iso-osmolar contrast agents are associated with an equal or lower rate of MACE compared to low osmolar contrast agents.
The researchers evaluated data on 521,437 patients from Jan. 1, 2007, through Dec. 31, 2008, in the Premier Perspective Database, which contain de-identified admission-level data from more than 600 U.S. acute-care hospitals. They assessed 118,271 high-risk patients (54.1 percent females, mean age 63.7) and 403,166 low-risk patients (49.8 percent females, mean age 63.1).
To compare costs between iodixanol (Visipaque; GE Healthcare) and iopamidol (IsoVue; Bracco Diagnostics) in the overall population, the investigators used rates from the VICC trial. The VICC trial was a multicenter, prospective, randomized, double-blind trial conducted with 1,276 patients undergoing PCI. To compare costs between iodixanol and ioxaglate (Hexabrix; Guerbet) among high-risk patients, they used rates from the COURT trial. The COURT trial was a multicenter, prospective, randomized, double-blind trial performed in 856 high-risk patients undergoing coronary artery intervention.
Among the 521,437 patients undergoing a cardiac cath/PCI, Meissner and colleagues found that 2.5 percent (13,149 patients) experienced a MACE; high-risk patients had a higher rate of MACE compared to low-risk patients (4.1 vs. 2.1 percent). For those experiencing MACE, high-risk patients had longer overall length of stay (4.2 vs. 3.3 days) and longer ICU length of stay (2.6 vs. 2.3 days) For MACE patients, those who were at high risk had greater total costs during the initial visit and 30 days post-visit.
After applying literature-based rates, utilizing the iso-osmolar agent iodixanol could potentially save hospitals $54,617 per 100 patients when compared to the low osmolar nonionic agent iopamidol, according to the authors. Similarly, utilization of the iso-osmolar agent iodixanol in high-risk patients may save up to $61,582 per 100 patients when compared to the low osmolar ionic agent ioxaglate.
The authors found that iso-osmolar contrast agent iodixanol may reduce the rate of MACE compared with iopamidol and compared with ioxaglate in high-risk patients. “The cost difference for resource utilization associated with cardiac cath and PCI shown by this analysis for iodixanol versus ioxaglate is approximately $61,000 and for iodixanol versus iopamidol is approximately $55,000,” they wrote.