PSU5 ECONOMIC IMPACT OF PULMONARY ARTERY CATHETER UTILIZATION AMONG CARDIAC SURGERY PATIENTS: PERSPECTIVES FOR AN ACUTE CARE HOSPITAL AND AN INTEGRATED PAYER-PROVIDER HEALTH SYSTEM

Abstract

A recent study demonstrated pulmonary artery catheter (PAC) use surrounding cardiac surgery is associated with a significant decrease in the incidence of new onset heart failure (HF) and respiratory failure (RF), while bacteremia and urinary infection complication rates significantly increased, as compared to patients that did not receive a PAC. We evaluated the economic impact of perioperative monitoring PAC utilization for adult cardiac procedures to support decision-making regarding PAC adoption for an acute care hospital and an integrated payer-provider health system. An Excel-based model was created to estimate the annualized savings for a US acute care hospital utilizing a monitoring PAC perioperatively for cardiac procedures during the index visit. A second model for an integrated payer-provider included costs for the index visit and for treatment of persistent index visit-related HF and RF complications over the following year (excluding patients with history of these conditions). Complication rates, costs, and healthcare utilization inputs were extracted from literature and a national database. Scenario analyses with varying surgical volume and PAC adoption rates were performed, as were one-way and probabilistic sensitivity analyses. For an acute care hospital, base-case (500 cardiac surgeries/year, 34% PAC adoption) annualized savings for the index visit totaled US$61,806 vs. no PAC utilization. Scenario analyses with cardiac surgical volumes of 100 and 1,500 procedures/year resulted in estimated savings of US$12,361 and US$185,418, respectively. Increased PAC adoption rates (75% and 95%) were associated with increased savings: US$134,751 and US$170,685, respectively, for 500 procedures/year. HF and RF treatment costs had the largest impact on savings. For an integrated payer-provider, base-case (3,845 cardiac surgeries/year, 34% PAC adoption) resulted in estimated savings of US$596,637 for the index visit and treatment of related complications over the following year. Monitoring PAC utilization for adult cardiac surgeries generates significant savings for acute care hospitals and integrated payer-provider systems.