BUDGET IMPACT AND CAPACITY-GENERATION ANALYSIS OF A POST-PROCEDURAL CLINICAL DECISION SUPPORT SYSTEM FOR LENGTH-OF-STAY OPTIMIZATION IN ELECTIVE PERCUTANEOUS CORONARY INTERVENTION ACROSS TWO ASIA-PACIFIC PUBLIC HEALTH SYSTEMS...
Author(s)
Jeff Hsu, MA, MD, Arthur Schahin, BS, Tomoyasu Muto, BS, MSc, PhD.
Serv Medical, Singapore, Singapore.
Serv Medical, Singapore, Singapore.
OBJECTIVES: Conservative discharge protocols prolong hospitalization after percutaneous coronary intervention (PCI), consuming bed-days that constrain throughput and lengthen elective waiting queues, despite consensus that same-day and 2-3 day discharge is safe for uncomplicated elective PCI. This study estimated the budget impact, bed-day capacity generation, incremental throughput, and gross procedural revenue of a post-procedural clinical decision support system (CDSS) providing algorithmic discharge-readiness scoring versus standard of care for elective PCI and diagnostic angiography across two Asia-Pacific public health systems (Singapore and Thailand), from payer and societal perspectives over a one-year horizon.
METHODS: A two-arm model (CDSS versus standard of care) was applied to elective PCI and angiography; emergent PCI was excluded. A representative public hospital was scaled to national volume. Cost savings counted post-procedural bed-days only; throughput counted total hospitalization days. Post-procedural length of stay was modeled 4-to-2 days (Singapore) and 2-to-1 day (Thailand); angiography 2.25-to-1.0 days. Costs were PPP-adjusted to US dollars (USD$). Thailand inputs used the nationwide Thai PCI Registry; Singapore used institutional volume and Ministry of Health bill data. One-way sensitivity analyses and a break-even threshold were derived.
RESULTS: Per-patient savings were USD$3,333 (Singapore) and USD$640 (Thailand) for elective PCI. Combined national estimates were approximately USD$65 million in annual savings, 72,100 bed-days freed, 5,120 additional elective PCI of capacity, and USD$68 million in gross procedural revenue. Savings and throughput revenue are non-additive. Results were robust across plus-or-minus 20% cost ranges and net-positive at any length-of-stay reduction above zero.
CONCLUSIONS: CDSS-enabled discharge-readiness scoring is projected to deliver substantial savings, freed capacity, and shorter waiting times across two public health systems, warranting prospective validation.
METHODS: A two-arm model (CDSS versus standard of care) was applied to elective PCI and angiography; emergent PCI was excluded. A representative public hospital was scaled to national volume. Cost savings counted post-procedural bed-days only; throughput counted total hospitalization days. Post-procedural length of stay was modeled 4-to-2 days (Singapore) and 2-to-1 day (Thailand); angiography 2.25-to-1.0 days. Costs were PPP-adjusted to US dollars (USD$). Thailand inputs used the nationwide Thai PCI Registry; Singapore used institutional volume and Ministry of Health bill data. One-way sensitivity analyses and a break-even threshold were derived.
RESULTS: Per-patient savings were USD$3,333 (Singapore) and USD$640 (Thailand) for elective PCI. Combined national estimates were approximately USD$65 million in annual savings, 72,100 bed-days freed, 5,120 additional elective PCI of capacity, and USD$68 million in gross procedural revenue. Savings and throughput revenue are non-additive. Results were robust across plus-or-minus 20% cost ranges and net-positive at any length-of-stay reduction above zero.
CONCLUSIONS: CDSS-enabled discharge-readiness scoring is projected to deliver substantial savings, freed capacity, and shorter waiting times across two public health systems, warranting prospective validation.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE40
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)