Table 3.
Cost of potential cascade services after low-value preoperative electrocardiogram (EKG)
| Average unadjusted cost per Veteran | Unadjusted cascade-attributable cost per Veteran† ($) | Adjusted cascade-attributable cost per Veteran (95% CI)‡ ($) | ||
|---|---|---|---|---|
| Cascade service* | Low value-EKG group ($) (n=49,820) |
Comparison group ($) (n=586,004) |
||
| Any cascade service | 123.3 | 45.9 | 77.3 | 101.7 (89.6–113.9) |
| Outpatient EKG | 14.0 | 5.0 | 9.0 | 9.0 (7.6–10.3) |
| Outpatient visit for abnormal EKG§ | 0.6 | 0.3 | 0.3 | 0.4 (0.2–0.6) |
| Outpatient visit to cardiologist | 4.4 | 2.1 | 2.3 | 3.3 (3.1–3.6) |
| Troponin | 1.5 | 0.6 | 0.9 | 0.8 (0.7–1.0) |
| Brain natriuretic peptide | 4.4 | 2.1 | 2.3 | 2.5 (2.0–3.0) |
| Echocardiogram | 48.4 | 18.0 | 30.5 | 37.7 (34.5–40.8) |
| Stress test | 14.9 | 5.5 | 9.4 | 13.9 (11.6–16.3) |
| Other cardiac imaging‖ | 2.7 | 0.8 | 1.9 | 2.2 (0.8–3.6) |
| Evaluation for arrhythmia‖ | 17.8 | 5.5 | 12.3 | 16.5 (9.9–23.1) |
| Cardiac catheterization | 14.6 | 6.1 | 8.6 | 15.4 (9.1–21.7) |
CABG coronary artery bypass graft, EKG electrocardiogram
*Cost data unavailable for CPT codes associated with CABG/coronary repair and valve replacement/repair
†Determined by subtracting cost of care cascade services per Veteran in those who did not receive a low-value preoperative EKG from those who did receive a low-value preoperative EKG
‡Adjusted for patient and facility-level covariates (age, sex, race/ethnicity, VA priority group, driving distance to nearest VA, number of Elixhauser conditions, individual Elixhauser conditions, academic affiliation, facility size, census region, rurality, complexity level) and surgery type using propensity score weighting
§Outpatient visit with primary diagnosis of abnormal electrocardiogram, abnormal result of cardiovascular function study, abnormal findings on diagnostic imaging of heart and coronary circulation, not including cardiology visits
‖Includes cardiac magnetic resonance imaging (cMRI), cardiac positron emission tomography (PET), nuclear imaging, coronary ultrasound, coronary computed tomography angiography (CTA)
‖Includes Holter monitor, event monitor, implantable loop recorder, electrophysiology (EP) testing, EP procedure, pacemaker evaluation, pacemaker procedure