Potential unrecognised costs of clopidogrel pretreatment in acute coronary syndrome

Jay P. Bae, Paul P. Dobesh, Patrick L. McCollam, Ali Khoynezhad

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To examine adherence in clinical practice to the American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations of observing a 5-day waiting period after clopidogrel administration before undergoing coronary artery bypass graft (CABG) surgery and to examine the costs of waiting. Methods: This retrospective study used a nationwide inpatient database (Solucient ACTracker) to identify patients who were admitted for acute coronary syndrome (ACS), and who had same-stay CABG. Cost of additional days of stay was estimated using regression analysis. Results: The recommended 5-day waiting was adhered to in 16.9% (n=3,809) of patients. The percentage of patients with ACS undergoing CABG surgery on day 0 was 14.6%. Adherence to the waiting was higher for teaching and rural hospitals; and in female and elderly patients and urgent admissions. Conclusions: The recommended 5-day waiting for CABG surgery after clopidogrel treatment is poorly adhered to in clinical practice. This study was unable to determine specific reasons for the low adherence; however, there may be a compromise between the clinically urgent need for revascularisation and increased risk of bleeding, as well as economic costs associated with waiting. The cost of an additional hospital day in this group of patients was approximately £1,400 per day or £7,000 for 5 days. Thus, a full 5-day wait would have a significant economic impact on hospital costs.

Original languageEnglish (US)
Pages (from-to)325-330
Number of pages6
JournalJournal of Medical Economics
Volume12
Issue number4
DOIs
StatePublished - Dec 1 2009

Fingerprint

clopidogrel
Acute Coronary Syndrome
Coronary Artery Bypass
Transplants
Costs and Cost Analysis
Hospital Costs
Economics
Rural Hospitals
Patient Admission
Practice Guidelines
Teaching Hospitals
Inpatients
Retrospective Studies
Regression Analysis
Databases
Hemorrhage

Keywords

  • Acute coronary syndrome
  • CABG
  • Clopidogrel
  • Hospital cost
  • Pretreatment

ASJC Scopus subject areas

  • Health Policy

Cite this

Potential unrecognised costs of clopidogrel pretreatment in acute coronary syndrome. / Bae, Jay P.; Dobesh, Paul P.; McCollam, Patrick L.; Khoynezhad, Ali.

In: Journal of Medical Economics, Vol. 12, No. 4, 01.12.2009, p. 325-330.

Research output: Contribution to journalArticle

Bae, Jay P. ; Dobesh, Paul P. ; McCollam, Patrick L. ; Khoynezhad, Ali. / Potential unrecognised costs of clopidogrel pretreatment in acute coronary syndrome. In: Journal of Medical Economics. 2009 ; Vol. 12, No. 4. pp. 325-330.
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