Evidence of systematic duplication by new percutaneous coronary intervention programs

Abstract

Background: Evidence suggests that recent and projected future investments in percutaneous coronary intervention (PCI) programs at US hospitals fail to increase access to timely reperfusion for patients with ST-segment elevation myocardial infarction.

Methods and results: We set out to estimate the annual number and costs of new PCI programs in US hospitals from 2004 to 2008 and identify the characteristics of hospitals, neighborhoods, and states where new PCI programs have been introduced. We estimated a discrete-time hazard model to measure the influence of these characteristics on the decision of a hospital to introduce a new PCI program. In 2008, 1739 US hospitals were capable of performing PCI, a relative increase of 16.5% (251 hospitals) over 2004. The percentage of the US population with projected access to timely PCI grew by 1.8%. New PCI programs were more likely to be introduced in areas that already had a PCI program with more competition for market share, near populations with higher rates of private insurance, in states that had weak or no regulation of new cardiac catheterization laboratories, and in wealthier and larger hospitals.

Conclusions: Our data show that new PCI programs were systematically duplicative of existing programs and did not help patients gain access to timely PCI. The total cost of recent US investments in new PCI programs is large and of questionable value for patients.

Keywords: ST-segment elevation myocardial infarction; angioplasty; catheterization; mapping; percutaneous coronary intervention.

Figure 1. Timely Access to Primary PCI from 251 New PCI Programs (2005–2008)

This map illustrates sixty-minute drive times surrounding 251 PCI programs at U.S. hospitals that were newly introduced in 2005–2008. Black-shaded areas depict Census tracts that already had timely access to PCI in 2004 and for which the new program represented duplication. Grey-shaded areas depict Census tracts that did not have timely access to PCI in 2004 and for which the new PCI program represented new access.