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Reduced Rate and Cost Of Complications

16/07/2019 -  

​A Cost-Minimization Analysis of the Angio-Seal Vascular Closure Device Following Percutaneous Coronary Intervention


Resnic FS, et al. A cost-minimization analysis of the Angio-Seal vascular closure device following percutaneous coronary intervention (PCI). Am J Cardiol. 2007;99(6):766-70.

DESCRIPTION

Objective: Explore the health economic implications of routinely using the Angio-Seal vascular closure device after PCI

  • 3.943 patients who underwent PCI January 2002 through December 2004 were followed prospectively through time of discharge. Full cost accounting and hospital records were available for analysis

  • A model was constructed to compare the expected cost to the hospital of a patient receiving the Angio-Seal device after PCI with that of a patient receiving mechanical compression



KEY FINDINGS

  • The hospital realized a net cost savings of $44 for each study patient who received an Angio-Seal device over those treated with mechanical compression

  • The economic benefit of the Angio-Seal device reflected the higher rate of access site bleeding and pseudoaneurysm in the mechanical compression group

  • Cost of vascular complications can ranged from $1.399 for a hematoma to $6.698 for a retroperitoneal hemorrhage.

  • A sensitivity analysis found that the cost of compression would have to drop below $66 to become more cost-effective than the Angio-Seal device



CONCLUSION

  • Cost-minimization continues to drive many decisions in healthcare institutions. This retrospective review demonstrated the economic benefit realized when selecting to treat PCI patients with the Angio-Seal vascular closure device versus mechanical compression.

Network Meta-analysis of Randomised Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis.


Jun Jiang et al. Network Meta-analysis of Randomised Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis. Sci Rep.; 5:13761. 2015.


DESCRIPTION

Objective: Network meta-analysis comparing the safety of different VCDs.

  • 40 RCTs with 16.868 patients

  • Comparison of different VCDs vs MC with patients undergoing diagnostic and/or interventional femoral procedures

  • Traditional meta-analysis: no significant difference in the rate of Combined Adverse Vascular Events (CAVEs) between all the VCDs and manual compression (MC)


KEY FINDINGS

Results

1. Direct meta-analysis:

  • Traditional meta-analysis: risk for CAVE is similar between VCDs and MC

  • Subgroup analysis: similar results, but FemoSeal showed significantly reduced risk of CAVE

  • Haematoma risk: significantly lower with VCDs vs MC (RR: 0.80, CI: 0.71-0.90)

  • Design improvements of VCDs & increased user experience -> decreases risk of CAVE


​​Vascular closure devices

N° of studies

​Total Patients 

​M-H, random

Heterogeneity​

​Test for overal effect

​RR (95% CI)

​Chi2/I2

​Z value 

​P value

​Angio-Seal

​13

​3264

​0.69 [0.46, 1.03]

​44.41/0.73

​1.81

​0.07

​Vasoseal

​7

​1301

1.10 [0.75, 1.61]

​22.68/0.74

​0.46

​0.64

​Exoseal

​2

​3416

1.45 [0.55, 3.84]

​3.51/0.72

​0.75

​0.45

​QuickSeal

​2

​539

1.27 [0.48, 3.37]

​2.40/0.58

​0.49

​0.63

​FemoSeal

​2

​4019

0.75 [0.60, 0.94]

​0.00/0.00

​2.46

​0.01*

​Perclose

9​

​2311

1.00 [0.65, 1.52]

​14.89/0.46

​0.02

​0.99

​StarClose

​3

​1132

0.63 [0.29, 1.37]

​5.27/0.62

​1.17

​0.24

*Statistically significant.

2. Network analysis on CAVE:

  • Angio-Seal – reduced risk of CAVE vs MC (RR: 0.67, CI: 0.46–0.98)

  • Other VCDs: similar risk for CAVE vs MC. No difference in risk for CAVE between different VCDs.


CONCLUSION
  • The use of VCDs significantly decreased the risk of haematomas

  • The newly developed VCDs significantly reduced the rate of CAVE

  • FemoSeal also significantly reduced the risk of CAVE. Newer VCDs with advanced design might improve the safety of VCDs

  • Angio-Seal, which might be the best VCD among all included VCDs, reduced the rate of both CAVE and haematomas vs MC