Healthcare and Economic Impact of Lung Perfusion Scintigraphy in Patients Affected by Acute Pulmonary Embolism
Abstract
:1. Introduction
Importance and Objectives
2. Materials and Methods
2.1. Patient Population—Organisation
2.2. Lung Perfusion Scintigraphy (LPS): Acquisition and Interpretation Criteria
2.3. Risk Stratification and Homecare
- High risk, for those patients who present shock or hypotension. Due to the high rate of in-hospital mortality, especially in the first hours after hospitalisation, they must be addressed to thrombolytic therapy or, if contraindicated or not enough, to surgical embolectomy. These patients need hospitalisation with intensive care;
- Intermediate risk, for those patients in apparent hemodynamic stability on admission showing signs of right ventricular dysfunction and/or myocardial injury. The initial preferred anticoagulant therapy is unfractionated intravenous therapy. These patients need ordinary hospitalisation;
- Low risk, for those patients without any primary APE-related risk factors for whom early discharge can be planned with adequate outpatient care and anticoagulant therapy can be provided (subcutaneous low-molecular-weight heparin; new oral anticoagulants).
2.4. Clinical Decision Models
2.5. Cost Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Name | Description | Basal Value | Sensitivity Range Values (±25%) | Source |
---|---|---|---|---|
Prevalence high risk | Prevalence of PE subjects needing hospitalisation in ICU | 204/1846 (11.1%) | 8.3%, 13.8% | Internal retrospective data |
Prevalence medium risk | Prevalence of PE subjects needing ordinary hospitalisation | 96/1846 (5.2%) | 3.9%, 6.5% | Internal retrospective data |
Percentage of subjects with early discharge | Percentage of subjects in ordinary hospitalisation who are discharged early, which determines a low fare | 16.2% | 12.2%, 20.3% | Stein et al. [17] |
Daily cost of intensive care hospitalisation | Daily cost of hospitalisation for pulmonary embolism for patients requiring intensive care | EUR 1800 | EUR 1350.00, EUR 2250.00 | Expert opinion |
Duration of intensive care hospitalisation | Number of days of hospitalisation for pulmonary embolism for patients requiring intensive care (average number) | 7 days | / | Expert opinion |
Cost of 1-day ordinary hospitalisation | Cost of the DRG 78 (pulmonary embolism) for patients discharged after 1 day | EUR 405 | 303.75 €, 506.25 € | Italian National Fares [18] |
Cost of ordinary hospitalisation | Cost of the DRG 78 (pulmonary embolism) in ordinary hospitalisation | EUR 4009 | EUR 3006.75, EUR 5011.25 | Italian National Fares [18] |
Cost of lung perfusion scintigraphy | Cost for executing an ordinary scintigraphy (i.e., during the morning regimen) | EUR 68.48 | EUR 51.36, EUR 85.60 | Italian National Fares [19] |
Additional cost of pulmonary scintigraphy in emergency | Additional cost for executing an ordinary scintigraphy (i.e., during the evening/night regimen) | EUR 41.32 | EUR 30.99, EUR 51.65 | Internal retrospective data |
Cost of SPET/CT supplemented LPS | The additional cost of an LPS when executed with SPET or SPET/CT | EUR 34.71 | EUR 26.03, EUR 43.39 | Italian National Fares [19] |
Percentage of subjects with nondiagnostic LPS | Percentage of subjects with a nondiagnostic LPS that requires LPS complemented with SPET or SPET/CT | 20% | 15.0%, 25.0% | Internal retrospective data |
Percentage of LPS in emergency | Percentage of LPS instances executed during the emergency timeframe | 1157/1846 (62.7%) | 47.0%, 78.3% | Internal retrospective data |
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Rubini, G.; Ferrari, C.; Mammucci, P.; Pisani, A.R.; Mincarone, P.; Leo, C.G. Healthcare and Economic Impact of Lung Perfusion Scintigraphy in Patients Affected by Acute Pulmonary Embolism. Healthcare 2021, 9, 716. https://doi.org/10.3390/healthcare9060716
Rubini G, Ferrari C, Mammucci P, Pisani AR, Mincarone P, Leo CG. Healthcare and Economic Impact of Lung Perfusion Scintigraphy in Patients Affected by Acute Pulmonary Embolism. Healthcare. 2021; 9(6):716. https://doi.org/10.3390/healthcare9060716
Chicago/Turabian StyleRubini, Giuseppe, Cristina Ferrari, Paolo Mammucci, Antonio Rosario Pisani, Pierpaolo Mincarone, and Carlo Giacomo Leo. 2021. "Healthcare and Economic Impact of Lung Perfusion Scintigraphy in Patients Affected by Acute Pulmonary Embolism" Healthcare 9, no. 6: 716. https://doi.org/10.3390/healthcare9060716