A Cost-Minimization Analysis of the Angioseal Vascular Closure Device following Percutaneous Coronary Intervention

摘要

The Angioseal vascular closure device has been shown to be safe and effective in reducing the time to hemostasis following percutaneous coronary intervention (PCI). The health economic implications of routinely using Angioseal after PCI have not been explored. We performed a cost-minimization analysis comparing routine Angioseal use after PCI to mechanical compression using a decision analytic model. The relative probabilities of 7 vascular access complications were derived from pooled analysis of published randomized trials. The incremental hospital cost of each vascular complication was estimated by a matched case control analysis of 3,943 patients who underwent PCI at our center between 1/02 and 12/04. Appropriate sensitivity and uncertainty analyses were performed. After accounting for differences in expected rates of specific complications between the two strategies, as well as the incremental costs of each vascular event, the routine use of Angioseal was associated with a reduced cost per PCI procedure of $44. Probabilistic sensitivity analysis of all model assumptions using second order Monte Carlo simulation confirmed the economic advantage of Angioseal in 74% of model replications. In conclusion, following PCI, the routine use of Angioseal for femoral vascular access management was associated with net cost savings as compared with mechanical compression. This cost savings was in addition to the previously demonstrated advantages of Angioseal in terms of patient comfort and preference.