A rational cost-assessment system should take risk factors into consideration: an evaluation of package pricing for coronary angiography procedures

OBJECTIVES
Package pricing is applied to diagnostic and therapeutic modalities of cardiovascular diseases as well as to those of other medical branches. This study was designed to compare the actual costs and the package prices of coronary angiography procedures performed in the Cardiology Clinic of Turkey Yuksek Ihtisas Hospital.
STUDY DESIGN
The study included coronary angiography procedures performed in November and June, the most and the least number of procedures seen in 2003, respectively. A total of 294 consecutive patients (134 women, 160 men; mean age 58±11 years) were enrolled. The overall price calculated at the time of discharge was evaluated as the target variable. Patient- and disease-related variables included length of stay, sex, age, accompanying severe valve diseases, aortic insufficiency, mild to moderate mitral and aortic stenosis, renal or hepatic dysfunction, systolic heart failure, obesity, previous bypass operations, hypertension, and diabetes mellitus. Multiple linear regression analysis was used to determine independent cost predictors.
RESULTS
Renal dysfunction, accompanying severe valve disease, age above 65 years, and prolonged length of stay (>3 days) were found to significantly increase the overall costs. In multiple regression analysis, renal dysfunction (p<0.001), severe valve disease (p=0.011), and prolonged length of stay (p<0.001) were independent variables. Comparison between the package prices and the actual costs showed that the beneficial role of the package pricing was at most confined to the 20-percent of risk distribution, and the more risks involved, the more it was at the expense of the hospital.
CONCLUSION
To avoid economic losses on the part of hospitals, risk groups should be taken into consideration in the implementation of package pricing policy.