Economic Evaluation of Dynamic Coronary Roadmap (DCR) in Percutaneous Coronary Intervention (PCI)

OBJECTIVES: There is a rise in the global incidence of high-risk patients undergoing PCI procedures (Waldo SW et al, 2018). During these procedures, iodine contrast media is used to visualize the coronary arteries. This media poses a risk to renal health, potentially leading to contrast-induced acute kidney injury (CI-AKI) post-procedure. This economic evaluation aims to examine the hospital budget impact of implementing DCR in a US hospital setting. DCR is a technology that provides motion-compensated, real-time visualization of coronary arteries. With DCR, less iodinated contrast is required and subsequently the risk of CI-AKI is reduced.

METHODS: A budget impact model was developed comparing DCR vs. no DCR from a US hospital perspective. The number of PCI procedures per hospital was derived from Definitive US healthcare data, while data from a large registry (Tsai TT et al., 2014) was used to determine the distribution of patients across different iodine contrast volumes. Iodine contrast volume buckets of ‘<100 mL’, ‘100 mL – 100 mL’, ‘200 mL – 299 mL’, ‘>200 mL’ and the associated risk of CI-AKI were defined as per Mehran et al, 2021. DCR has shown to reduce iodine contrast volume by 28.8% (Hennessey B et al, 2024). This figure was used to redistribute the patients across the different buckets and determine the distribution in the DCR arm. The cost of AKI was obtained from Amin AP et al. (2020), which identified room and board as major cost contributors.

RESULTS: Offsetting the cost of the DCR system depends on the risk and cost of CI-AKI, timeframe, and the number of PCI procedures. For 1,000 patients, cost savings of approximately $280,000 are realized over 2 years.

CONCLUSIONS: Hospitals adopting the DCR platform can realize cost savings compared to the conventional pathway without DCR, while also delivering better patient outcomes in the form of avoided AKIs.