This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Omoigui, N. A. Articles by Hlatky, M. A. Search for Related Content PubMed PubMed Citation Articles by Omoigui, N. A. Articles by Hlatky, M. A.

(Circulation. 1995;91:1070-1076.)
© 1995 American Heart Association, Inc.

Articles

Cost of Initial Therapy in the Electrophysiological Study Versus ECG Monitoring Trial (ESVEM)

Nowamagbe A. Omoigui, MD, MPH; Frank I. Marcus, MD; Jay W. Mason, MD; Elizabeth A. Hahn, MA; Vernon L. Hartz, MS; Mark A. Hlatky, MD; for the ESVEM Investigators

From the Division of Health Services Research, Department of Health Research and Policy, and the Division of Cardiovascular Medicine, Department of Medicine, Stanford (Calif) University School of Medicine (N.A.O., M.A.H.); the Cardiology Division, Department of Medicine, University of Arizona School of Medicine, Tucson (F.I.M., E.A.H., V.L.H.); and the Cardiology Division, Department of Medicine, University of Utah School of Medicine, Salt Lake City (J.W.M.).

Background Patients randomized to either serial electrophysiological testing (EPS) or serial Holter monitoring (HM) to guide antiarrhythmic therapy for life-threatening ventricular arrhythmias had equivalent rates of mortality and arrhythmia recurrence in the ESVEM study. This report analyzes the effects of EPS, HM, and clinical factors on the charges for initial evaluation and management of patients with life-threatening ventricular arrhythmias.

Methods and Results Ten of 14 clinical centers participating in ESVEM provided bills from the initial hospitalization for randomized patients. Predictors of charges (1991 dollars) were analyzed by linear regression after logarithmic transformation. Initial hospital charge data were obtained for 286 patients randomized in ESVEM (88% of patients eligible for this substudy, 59% of all ESVEM patients). Patients with charge data were somewhat more likely to be older, to be female, and to have failed previous antiarrhythmic drug therapy at study entry and were less likely to have a drug predicted effective after randomization. Mean overall hospital charges were $35 986 (SD, $32 628) with a median of $24 532 (interquartile range, $16 126 to $43 593). Prerandomization patient characteristics generally had insignificant effects on charges, with the exception of presentation with resuscitated sudden death (28% increase in charges, P=.01) and heart failure (26% increase in charges, P=.02). Patients randomized to EPS had higher mean charges for evaluation ($42 002 versus $29 970, P=.0015) as well as more drug trials (3.0 versus 2.1, P=.0001) and a longer hospital stay (19.6 versus 13.9 days, P=.0007). In a multivariate regression model, failure to find an effective drug (P=.0001), the number of drug trials (P=.0001), and resuscitated sudden death as the presenting arrhythmia (P=.0001) were the only independent predictors of higher initial charges.

Conclusions (1) Initial hospital charges are significantly higher for EPS-guided than HM-guided therapy. (2) The higher charges for EPS-guided therapy were due to a greater number of drug trials and a lower probability of finding an effective drug. (3) Failure to find an effective drug, a larger number of drug trials, and a history of resuscitated sudden death independently predict higher charges.

Key Words: clinical trials • electrophysiology • death, sudden

This article has been cited by other articles:

				M. P. Anstadt and J. E. Lowe Cardiopulmonary Resuscitation Card. Surg. Adult, January 1, 2003; 2(2003): 471 - 494. [Full Text]