Cost of initial therapy in the Electrophysiological Study Versus ECG Monitoring trial (ESVEM).
Cost of initial therapy in the Electrophysiological Study Versus ECG Monitoring trial (ESVEM).
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电生理学研究与心电图监测试验 (ESVEM) 初始治疗的费用。
DOI：
10.1161/01.cir.91.4.1070
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发表时间：
1995
期刊：
影响因子：
37.8
通讯作者：
Hlatky,MA
中科院分区：
文献类型：
--
作者：
Omoigui,NA;Marcus,FI;Mason,JW;Hahn,EA;Hartz,VL;Hlatky,MA
在ESVEM研究中，患者随机接受连续电生理检测(EPS)或连续动态心电图监测(HM)以指导危及生命的室性心律失常的抗心律失常治疗，其死亡率和心律失常复发率相同。本报告分析了EPS、HM和临床因素对危及生命的室性心律失常患者初始评估和治疗费用的影响。方法与结果参加ESVEM的14个临床中心中，有10个为随机选择的患者提供了首次住院费用。对收费(1991美元)的预测因素进行对数变换后的线性回归分析。获得了在ESVEM中随机抽取的286名患者的初始住院费用数据(88%的患者符合这项分研究的条件，59%的ESVEM患者符合条件)。有电荷数据的患者在某种程度上更有可能年龄更大，更有可能是女性，在研究开始时以前的抗心律失常药物治疗失败，并且在随机分组后预测药物有效的可能性较小。平均住院总费用为35 986美元(SD，32 628美元)，中位数为24 532美元(四分位数范围为16 126美元至43 593美元)。随机化前患者的特征通常对费用影响不大，除了出现复苏性猝死(费用增加28%，P=.01)和心力衰竭(费用增加26%，P=0.02)。随机接受EPS治疗的患者平均评估费用更高(42 002美元比29 970美元，P=.0015)，药物试验更多(3.0比2.1，P=.0001)，住院时间更长(19.6天比13.9天，P=.0007)。在多因素回归模型中，未找到有效药物(P=.0001)、药物试验次数(P=.0001)和以心律失常为表现的复苏性猝死(P=.0001)是较高初始费用的唯一独立预测因素。结论(1)EPS引导的初始住院费用显著高于HM引导的治疗。(2)EPS引导治疗的费用较高是由于药物试验次数较多，找到有效药物的概率较低。(3)未能找到有效的药物、大量的药物试验和复苏性猝死病史独立地预示着更高的费用。
BackgroundPatients randomized to either serial electrophysiological testing (EPS) or serial Holter monitoring (HM) to guide antiarrhythmic therapy for life-threatening ventricular arrhythmias had equivalent rates of mortality and arrhythmia recurrence in the ESVEM study. This report analyzes the effects of EPS, HM, and clinical factors on the charges for initial evaluation and management of patients with life-threatening ventricular arrhythmias.Methods and ResultsTen of 14 clinical centers participating in ESVEM provided bills from the initial hospitalization for randomized patients. Predictors of charges (1991 dollars) were analyzed by linear regression after logarithmic transformation. Initial hospital charge data were obtained for 286 patients randomized in ESVEM (88% of patients eligible for this substudy, 59% of all ESVEM patients). Patients with charge data were somewhat more likely to be older, to be female, and to have failed previous antiarrhythmic drug therapy at study entry and were less likely to have a drug predicted effective after randomization. Mean overall hospital charges were $35 986 (SD, $32 628) with a median of $24 532 (interquartile range, $16 126 to $43 593). Prerandomization patient characteristics generally had insignificant effects on charges, with the exception of presentation with resuscitated sudden death (28% increase in charges,P=.01) and heart failure (26% increase in charges,P=.02). Patients randomized to EPS had higher mean charges for evaluation ($42 002 versus $29 970,P=.0015) as well as more drug trials (3.0 versus 2.1,P=.0001) and a longer hospital stay (19.6 versus 13.9 days,P=.0007). In a multivariate regression model, failure to find an effective drug (P=.0001), the number of drug trials (P=.0001), and resuscitated sudden death as the presenting arrhythmia (P=.0001) were the only independent predictors of higher initial charges.Conclusions(1) Initial hospital charges are significantly higher for EPS-guided than HM-guided therapy. (2) The higher charges for EPS-guided therapy were due to a greater number of drug trials and a lower probability of finding an effective drug. (3) Failure to find an effective drug, a larger number of drug trials, and a history of resuscitated sudden death independently predict higher charges.