International Journal of Applied Science and Engineering
Published by Chaoyang University of Technology

Tian-Shyug Lee1‡, Shao-Jung Li2,3,4‡, Yefei Jiang1, Ben-Chang Shia5, Mingchih Chen1*

1 Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
2 Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
3 Cardiovascular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
4 Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
5 College of Management, Taipei Medical University, Taipei, Taiwan
contributed equally


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ABSTRACT


In the aging world, coronary artery disease is the leading cardiovascular disease burden. Coronary artery bypass surgery grafting (CABG) entails high medical costs. Identifying the driving factors of medical cost variability is essential for health policies and the enhancement of quality of care. We conducted this study using data from the National Health Insurance Research Database (NHIRD) in the Longitudinal Health Insurance Database 2005, which includes 1 million randomly selected individuals from the 2005 registry of beneficiaries for their medical records collected between January 2000 and December 2013. We analyzed the in-hospital and one-year follow-up medical costs of patients with isolated CABG. Multiple linear regression models were developed to identify the effects of patient characteristics, comorbidities, and hospital-related factors on the surgical costs and the total one-year medical costs after discharge.
Female patients had significantly higher surgical costs and higher one-year medical costs after discharge. Hospital volume, surgeon’s age, surgeon’s operation volume and the number of anastomosis vessels affected CABG outcomes considerably. Both the surgeon’s age and volume negatively affected the one-year medical costs after discharge. Charlson comorbidity index (CCI), recent one-year medical costs before surgery, emergency surgery and extracorporeal membrane oxygenation (ECMO) use were correlated with higher one-year medical costs after discharge. Using multiple linear regression models could explain part of the variances for the one-year medical costs after discharge using fewer factors. We found that surgical cost and recent one-year medical costs before CABG were the most crucial predicting factors for the one-year medical costs after discharge. Cost analysis about the variations of in-hospital and recent one-year costs before CABG is essential information for determining health policy and further improving clinical quality.


Keywords: CABG, NHIRD, One-year medical costs after discharge, Surgical cost, Charlson comorbidity index (CCI) score.


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REFERENCES


  1. Biancari, F., Dalén, M., Perrotti, A., Fiore, A., Reichart, D., Khodabandeh, S., Gulbins, H., Zipfel, S., Al Shakaki, M., Welp, H. 2017. Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: Results of a multicenter study. International journal of cardiology. 241, 109–114.

  2. Birkmeyer, J.D., Siewers, A.E., Finlayson, E.V., Stukel, T.A., Lucas, F.L., Batista, I., Welch, H.G., Wennberg, D.E. 2002. Hospital volume and surgical mortality in the United States. New England Journal of Medicine. 346, 1128–1137.

  3. Chang, H.-Y., Bodycombe, D.P., Huang, W.-F., Weiner, J.P. 2015. Risk-adjusted resource allocation: using Taiwan’s National Health Insurance as an example. Asia Pacific Journal of Public Health. 27, NP958–NP971.

  4. Chen, S.-W., Chang, C.-H., Lin, Y.-S., Wu, V.C.-C., Chen, D.-Y., Tsai, F.-C., Hung, M.-J., Chu, P.-H., Lin, P.-J., Chen, T.-H. 2016. Effect of dialysis dependence and duration on post-coronary artery bypass grafting outcomes in patients with chronic kidney disease: a nationwide cohort study in Asia. International journal of cardiology. 223, 65–71.

  5. Chen, Y., Almeida, A.A., Goldstein, J., Shardey, G.C., Pick, A.W., Moshinsky, R., Kejriwal, N.K., Lowe, C., Jolley, D., Smith, J.A. 2006. Urgent and emergency coronary artery bypass grafting for acute coronary syndromes. ANZ journal of surgery. 76, 769–773.

  6. Deb, S., Wijeysundera, H.C., Ko, D.T., Tsubota, H., Hill, S., Fremes, S.E. 2013. Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review. Jama. 310, 2086–2095.

  7. Deppe, A.-C., Arbash, W., Kuhn, E.W., Slottosch, I., Scherner, M., Liakopoulos, O.J., Choi, Y.-H., Wahlers, T. 2015. Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16 900 patients investigated in randomized controlled trials. European Journal of Cardio-Thoracic Surgery. 49, 1031–1041.

  8. Fudulu, D., Benedetto, U., Pecchinenda, G.G., Chivasso, P., Bruno, V.D., Rapetto, F., Bryan, A., Angelini, G.D. 2016. Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials. Journal of thoracic disease. 8, S758.

  9. Giacomino, B.D., Cram, P., Vaughan-Sarrazin, M., Zhou, Y., Girotra, S. 2016. Association of hospital prices for coronary artery bypass grafting with hospital quality and reimbursement. American Journal of Cardiology. 117, 1101–1106.

  10. Hannan, E., O'donnell, J., KILBURN, J.R.H., Bernard, H., Yazici, A. 1990. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State Hospitals. Survey of Anesthesiology. 34, 175.

  11. Hannan, E.L., Kilburn, Jr.H., Bernard, H., O'Donnell, J.F., Lukacik, G., Shields, E.P. 1991. Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors. Medical care. 29, 1094–1107.

  12. Hannan, E.L., Siu, A.L., Kumar, D., Kilburn, H., Chassin, M.R. 1995. The decline in coronary artery bypass graft surgery mortality in New York State: the role of surgeon volume. Jama. 273, 209–213.

  13. Hannan, E.L., Wu, C., Ryan, T.J., Bennett, E., Culliford, A.T., Gold, J.P., Hartman, A., Isom, O.W., Jones, R.H., McNeil, B. 2003. Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates? Circulation. 108, 795–801.

  14. Kang, J.-H., Ho, J.-D., Chen, Y.-H., Lin, H.-C. 2009. Increased risk of stroke after a herpes zoster attack: a population-based follow-up study. Stroke. 40, 3443–3448.

  15. Kilic, A., Shah, A.S., Conte, J.V., Mandal, K., Baumgartner, W.A., Cameron, D.E., Whitman, G.J. 2014. Understanding variability in hospital-specific costs of coronary artery bypass grafting represents an opportunity for standardizing care and improving resource use. The Journal of thoracic and cardiovascular surgery. 147, 109–116.

  16. Lamy, A., Devereaux, P., Prabhakaran, D., Taggart, D.P., Hu, S., Paolasso, E., Straka, Z., Piegas, L.S., Akar, A.R., Jain, A.R. 2013. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. New England Journal of Medicine. 368, 1179–1188.

  17. Lin, H.-C., Xirasagar, S., Tsao, N.-W., Hwang, Y.-T., Kuo, N.-W., Lee, H.-C. 2008. Volume–outcome relationships in coronary artery bypass graft surgery patients: 5-year major cardiovascular event outcomes. The Journal of thoracic and cardiovascular surgery. 135, 923–930.

  18. Naglie, G., Tansey, C., Krahn, M.D., O'rourke, K., Detsky, A.S., Bolley, H. 1999. Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65. Canadian Medical Association Journal. 160, 805–811.

  19. Organization, W.H. 2004. International statistical classification of diseases and related health problems: World Health Organization.

  20. Osnabrugge, R.L., Speir, A.M., Head, S.J., Jones, P.G., Ailawadi, G., Fonner, C.E., Fonner, E.Jr., Kappetein, A.P., Rich, J.B. 2014. Prediction of costs and length of stay in coronary artery bypass grafting. Ann Thorac Surg. 98, 1286–93.

  21. Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.-C., Saunders, L.D., Beck, C.A., Feasby, T.E., Ghali, W.A. 2005. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical care. 1130–1139.

  22. Rathore, S.S., Epstein, A.J., Volpp, K.G., Krumholz, H.M. 2004. Hospital coronary artery bypass graft surgery volume and patient mortality, 1998–2000. Annals of surgery. 239, 110.

  23. Rodriguez, A.E., Baldi, J., Pereira, C.F., Navia, J., Alemparte, M.R., Delacasa, A., Vigo, F., Vogel, D., O'Neill, W., Palacios, I.F. 2005. Five-year follow-up of the Argentine randomized trial of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II). Journal of the American College of Cardiology. 46, 582–588.

  24. Romano, P.S., Roost, L.L., Jollis, J.G. 1993. Further evidence concerning the use of a clinical comorbidity index with ICD-9-CM administrative data. Journal of Clinical Epidemiology. 46, 1085–1090.

  25. Shinjo, D., Fushimi, K. 2015. Preoperative factors affecting cost and length of stay for isolated off-pump coronary artery bypass grafting: hierarchical linear model analysis. BMJ open. 5, e008750.

  26. Showstack, J.A., Rosenfeld, K.E., Garnick, D.W., Luft, H.S., Schaffarzick, R.W., Fowles, J. 1987. Association of volume with outcome of coronary artery bypass graft surgery: scheduled vs nonscheduled operations. Jama. 257, 785–789.

  27. Tomasco, B., Cappiello, A., Fiorilli, R., Leccese, A., Lupino, R., Romiti, A., Tesler, U.F. 1997. Surgical revascularization for acute coronary insufficiency: analysis of risk factors for hospital mortality. The Annals of thoracic surgery. 64, 678–683.

  28. Wu, C., Hannan, E.L., Ryan, T.J., Bennett, E., Culliford, A.T., Gold, J.P., Isom, O.W., Jones, R.H., McNeil, B., Rose, E.A. 2004. Is the impact of hospital and surgeon volumes on the in-hospital mortality rate for coronary artery bypass graft surgery limited to patients at high risk? Circulation. 110, 784–789.

  29. Wu, C.-Y., Chen, Y.-J., Ho, H.J., Hsu, Y.-C., Kuo, K.N., Wu, M.-S., Lin, J.-T. 2012. Association between nucleoside analogues and risk of hepatitis B virus–related hepatocellular carcinoma recurrence following liver resection. Jama. 308, 1906–1913.

  30. Youssef, A.A., Chang, L.-T., Hang, C.-L., Wu, C.-J., Cheng, C.-I., Yang, C.-H., Sheu, J.-J., Chai, H.-T., Chua, S., Yeh, K.-H. 2007. Level and value of interleukin-18 in patients with acute myocardial infarction undergoing primary coronary angioplasty. Circulation Journal. 71, 703–708.

  31. Yu, T.-H., Hou, Y.-C., Chung, K.-P. 2014. Do low-income coronary artery bypass surgery patients have equal opportunity to access excellent quality of care and enjoy good outcome in Taiwan? International journal for equity in health. 13, 64.

  32. Yu, T.-H., Hou, Y.-C., Tung, Y.-C., Chung, K.-P. 2015. Why do outcomes of CABG care vary between urban and rural areas in Taiwan? A perspective from quality of care. International Journal for Quality in Health Care. 27, 361–368.


ARTICLE INFORMATION


Received: 2019-11-07
Revised: 2020-01-16
Accepted: 2020-10-16
Available Online: 2020-12-01


Cite this article:

Lee, T.-S., Li, S.-J., Jiang, Y., Shia, B.-C., Chen, M. 2020. Cost analysis of coronary artery bypass grafting surgery under single-payer reimbursement in Taiwan. International Journal of Applied Science and Engineering, 17, 419–428. https://doi.org/10.6703/IJASE.202012_17(4).419

  Copyright The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are cited.