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 FINDINGSResults
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
