Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations.

L. J. Shaw, R. Hachamovitch, M. Cohen, D. S. Berman, S. Borges-Neto, J. E. Udelson, G. V. Heller, E. L. Eisenstein, K. A. Eagle, R. C. Hendel, Donald D Miller

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

The preoperative identification that patients are at high risk for adverse postoperative outcomes is the first step toward preventing costly in-hospital complications. The economic implications of noninvasive screening strategies in the care of patients undergoing peripheral vascular operations must be clarified. A decision model was developed from the peer-reviewed literature on patients undergoing preoperative screening by means of dipyridamole myocardial perfusion imaging, dobutamine echocardiography, or cardiac catheterization before vascular operations (n = 23 studies). Routine versus selective screening strategies were compared for patients with an intermediate likelihood of having coronary artery disease on the basis of clinical history of coronary disease or typical symptoms. Median costs (1994 US dollars) of preoperative screening strategies were derived with two microcosting approaches: adjusted Medicare charges (top-down approach) and a bottom-up approach with Duke University Center direct cost estimate data. In-hospital cost was 11% higher for preoperative screening by means of routine cardiac catheterization ($27,760) than for routine pharmacologic stress imaging ($24,826, P = 0.001). The total cost of a do-nothing strategy, that is, no preoperative testing, was 5.9% less than that of routine preoperative pharmacologic stress imaging and 15.9% lower than that of cardiac catheterization (P = 0.001). Selective screening among patients with a history of coronary disease or typical angina resulted in further reduction of the cost of care to a level comparable with that of a do-nothing strategy (52.5% reduction in cost with pharmacologic stress imaging, P > 0.20). Use of noninvasive testing for preoperative risk stratification was cost effective for patients 60 to 80 years of age. Cost per life saved ranged from $33,338 to $21,790. However, coronary revascularization after an abnormal noninvasive test was cost effective only for patients older than 70 years. In this economic decision model, substantial cost savings were predicted when selective noninvasive stress imaging was added to preoperative screening for patients about to undergo vascular operations. With a selective screening approach, the economic impact of initial diagnostic testing may be minimized without compromising patient outcomes.

Original languageEnglish (US)
Pages (from-to)1817-1827
Number of pages11
JournalThe American journal of managed care
Volume3
Issue number12
StatePublished - Jan 1 1997
Externally publishedYes

Fingerprint

Blood Vessels
Costs and Cost Analysis
Cardiac Catheterization
Coronary Disease
Economics
Economic Models
Myocardial Perfusion Imaging
Dobutamine
Dipyridamole
Cost Savings
Hospital Costs
Medicare
Echocardiography
Coronary Artery Disease
Patient Care

ASJC Scopus subject areas

  • Health Policy

Cite this

Shaw, L. J., Hachamovitch, R., Cohen, M., Berman, D. S., Borges-Neto, S., Udelson, J. E., ... Miller, D. D. (1997). Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations. The American journal of managed care, 3(12), 1817-1827.

Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations. / Shaw, L. J.; Hachamovitch, R.; Cohen, M.; Berman, D. S.; Borges-Neto, S.; Udelson, J. E.; Heller, G. V.; Eisenstein, E. L.; Eagle, K. A.; Hendel, R. C.; Miller, Donald D.

In: The American journal of managed care, Vol. 3, No. 12, 01.01.1997, p. 1817-1827.

Research output: Contribution to journalArticle

Shaw, LJ, Hachamovitch, R, Cohen, M, Berman, DS, Borges-Neto, S, Udelson, JE, Heller, GV, Eisenstein, EL, Eagle, KA, Hendel, RC & Miller, DD 1997, 'Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations.', The American journal of managed care, vol. 3, no. 12, pp. 1817-1827.
Shaw LJ, Hachamovitch R, Cohen M, Berman DS, Borges-Neto S, Udelson JE et al. Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations. The American journal of managed care. 1997 Jan 1;3(12):1817-1827.
Shaw, L. J. ; Hachamovitch, R. ; Cohen, M. ; Berman, D. S. ; Borges-Neto, S. ; Udelson, J. E. ; Heller, G. V. ; Eisenstein, E. L. ; Eagle, K. A. ; Hendel, R. C. ; Miller, Donald D. / Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations. In: The American journal of managed care. 1997 ; Vol. 3, No. 12. pp. 1817-1827.
@article{a179020cf869468d88434324dd536644,
title = "Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations.",
abstract = "The preoperative identification that patients are at high risk for adverse postoperative outcomes is the first step toward preventing costly in-hospital complications. The economic implications of noninvasive screening strategies in the care of patients undergoing peripheral vascular operations must be clarified. A decision model was developed from the peer-reviewed literature on patients undergoing preoperative screening by means of dipyridamole myocardial perfusion imaging, dobutamine echocardiography, or cardiac catheterization before vascular operations (n = 23 studies). Routine versus selective screening strategies were compared for patients with an intermediate likelihood of having coronary artery disease on the basis of clinical history of coronary disease or typical symptoms. Median costs (1994 US dollars) of preoperative screening strategies were derived with two microcosting approaches: adjusted Medicare charges (top-down approach) and a bottom-up approach with Duke University Center direct cost estimate data. In-hospital cost was 11{\%} higher for preoperative screening by means of routine cardiac catheterization ($27,760) than for routine pharmacologic stress imaging ($24,826, P = 0.001). The total cost of a do-nothing strategy, that is, no preoperative testing, was 5.9{\%} less than that of routine preoperative pharmacologic stress imaging and 15.9{\%} lower than that of cardiac catheterization (P = 0.001). Selective screening among patients with a history of coronary disease or typical angina resulted in further reduction of the cost of care to a level comparable with that of a do-nothing strategy (52.5{\%} reduction in cost with pharmacologic stress imaging, P > 0.20). Use of noninvasive testing for preoperative risk stratification was cost effective for patients 60 to 80 years of age. Cost per life saved ranged from $33,338 to $21,790. However, coronary revascularization after an abnormal noninvasive test was cost effective only for patients older than 70 years. In this economic decision model, substantial cost savings were predicted when selective noninvasive stress imaging was added to preoperative screening for patients about to undergo vascular operations. With a selective screening approach, the economic impact of initial diagnostic testing may be minimized without compromising patient outcomes.",
author = "Shaw, {L. J.} and R. Hachamovitch and M. Cohen and Berman, {D. S.} and S. Borges-Neto and Udelson, {J. E.} and Heller, {G. V.} and Eisenstein, {E. L.} and Eagle, {K. A.} and Hendel, {R. C.} and Miller, {Donald D}",
year = "1997",
month = "1",
day = "1",
language = "English (US)",
volume = "3",
pages = "1817--1827",
journal = "The American journal of managed care",
issn = "1088-0224",
publisher = "Ascend Media",
number = "12",

}

TY - JOUR

T1 - Cost implications of selective preoperative risk screening in the care of candidates for peripheral vascular operations.

AU - Shaw, L. J.

AU - Hachamovitch, R.

AU - Cohen, M.

AU - Berman, D. S.

AU - Borges-Neto, S.

AU - Udelson, J. E.

AU - Heller, G. V.

AU - Eisenstein, E. L.

AU - Eagle, K. A.

AU - Hendel, R. C.

AU - Miller, Donald D

PY - 1997/1/1

Y1 - 1997/1/1

N2 - The preoperative identification that patients are at high risk for adverse postoperative outcomes is the first step toward preventing costly in-hospital complications. The economic implications of noninvasive screening strategies in the care of patients undergoing peripheral vascular operations must be clarified. A decision model was developed from the peer-reviewed literature on patients undergoing preoperative screening by means of dipyridamole myocardial perfusion imaging, dobutamine echocardiography, or cardiac catheterization before vascular operations (n = 23 studies). Routine versus selective screening strategies were compared for patients with an intermediate likelihood of having coronary artery disease on the basis of clinical history of coronary disease or typical symptoms. Median costs (1994 US dollars) of preoperative screening strategies were derived with two microcosting approaches: adjusted Medicare charges (top-down approach) and a bottom-up approach with Duke University Center direct cost estimate data. In-hospital cost was 11% higher for preoperative screening by means of routine cardiac catheterization ($27,760) than for routine pharmacologic stress imaging ($24,826, P = 0.001). The total cost of a do-nothing strategy, that is, no preoperative testing, was 5.9% less than that of routine preoperative pharmacologic stress imaging and 15.9% lower than that of cardiac catheterization (P = 0.001). Selective screening among patients with a history of coronary disease or typical angina resulted in further reduction of the cost of care to a level comparable with that of a do-nothing strategy (52.5% reduction in cost with pharmacologic stress imaging, P > 0.20). Use of noninvasive testing for preoperative risk stratification was cost effective for patients 60 to 80 years of age. Cost per life saved ranged from $33,338 to $21,790. However, coronary revascularization after an abnormal noninvasive test was cost effective only for patients older than 70 years. In this economic decision model, substantial cost savings were predicted when selective noninvasive stress imaging was added to preoperative screening for patients about to undergo vascular operations. With a selective screening approach, the economic impact of initial diagnostic testing may be minimized without compromising patient outcomes.

AB - The preoperative identification that patients are at high risk for adverse postoperative outcomes is the first step toward preventing costly in-hospital complications. The economic implications of noninvasive screening strategies in the care of patients undergoing peripheral vascular operations must be clarified. A decision model was developed from the peer-reviewed literature on patients undergoing preoperative screening by means of dipyridamole myocardial perfusion imaging, dobutamine echocardiography, or cardiac catheterization before vascular operations (n = 23 studies). Routine versus selective screening strategies were compared for patients with an intermediate likelihood of having coronary artery disease on the basis of clinical history of coronary disease or typical symptoms. Median costs (1994 US dollars) of preoperative screening strategies were derived with two microcosting approaches: adjusted Medicare charges (top-down approach) and a bottom-up approach with Duke University Center direct cost estimate data. In-hospital cost was 11% higher for preoperative screening by means of routine cardiac catheterization ($27,760) than for routine pharmacologic stress imaging ($24,826, P = 0.001). The total cost of a do-nothing strategy, that is, no preoperative testing, was 5.9% less than that of routine preoperative pharmacologic stress imaging and 15.9% lower than that of cardiac catheterization (P = 0.001). Selective screening among patients with a history of coronary disease or typical angina resulted in further reduction of the cost of care to a level comparable with that of a do-nothing strategy (52.5% reduction in cost with pharmacologic stress imaging, P > 0.20). Use of noninvasive testing for preoperative risk stratification was cost effective for patients 60 to 80 years of age. Cost per life saved ranged from $33,338 to $21,790. However, coronary revascularization after an abnormal noninvasive test was cost effective only for patients older than 70 years. In this economic decision model, substantial cost savings were predicted when selective noninvasive stress imaging was added to preoperative screening for patients about to undergo vascular operations. With a selective screening approach, the economic impact of initial diagnostic testing may be minimized without compromising patient outcomes.

UR - http://www.scopus.com/inward/record.url?scp=0031317705&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031317705&partnerID=8YFLogxK

M3 - Article

VL - 3

SP - 1817

EP - 1827

JO - The American journal of managed care

JF - The American journal of managed care

SN - 1088-0224

IS - 12

ER -