Abstract 3237: The Economic Impact of Same-Day Discharge after Transradial Percutaneous Coronary Intervention and a Single Bolus of Abciximab; an Analysis from the EASY Trial
Bibliographic record
Abstract
Background: In patients presenting with an acute coronary syndrome, same-day home discharge (SDD) after an uncomplicated transradial percutaneous coronary intervention (PCI) performed under a single bolus of abciximab was found clinically non-inferior to the usual overnight hospitalization (OH) and an abciximab bolus followed by a 12h infusion. Objective: To estimate post-PCI health resources cost of trial subjects, and, using cost-minimization, immediate and short-term economic impact of same-day home discharge. Method: A total of 1005 patients were randomized to either the SDD group (n =504) or the OH (n = 501). As randomization was post-procedure, and PCI resource use showed minimal and non-significant differences, a post-PCI cost analysis was conducted. A hospital-based perspective was used. Detailed per patient information of healthcare resources used immediately post-PCI up to hospital discharge were prospectively collected. Costs were estimated based on 2006 Laval Hospital unit prices, and 2006 costs from the Centre Hospitalier de l’université de Montréal (CHUM) hospital costing system (direct and indirect costs). In addition, patient-reported resources for a period of 30 days post-discharge were examined. Results: Per hour post-PCI hospital costs were estimated as $113, based on average 2006 cost for all patients hospitalized for angioplasty plus stent (DRG 112) at the CHUM ($5716), net of estimated PCI-related cost ($1131), and divided by average post PCI length-of-stay of subjects. SDD patients stayed an average of 8.9 hours (95%CI from 8.2 to 9.5) post-PCI, compared to 26.5 hours (25.2–27.8) for OH patients. Mean estimated post-PCI hospital costs (including abciximab infusion when used, other medications, nursing time, meals, etc..) were $1004 ($929–$1079) in the SDD group versus $3117 ($2975–$3260) in the OH group, saving, on average, $2113 per patient (p<0.001). Within 30 days of discharge, only 50 patients were rehospitalized, 29 after SD discharge and 21 after OH (p=0.26). Conclusion: Same-day home discharge after an uncomplicated transradial PCI and a single bolus of abciximab resulted in a 68% relative saving in post PCI costs. In our trial, SDD of 504 patients saved over 1 million dollars to the hospital.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.012 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.010 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".