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Acute and long-term cost implications of coronary stenting
E D Peterson1, P A Cowper, E R DeLong
1Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. peter016@mc.duke.edu
Insights
Coronary stenting offers similar or better one-year outcomes than balloon angioplasty without increasing overall healthcare costs. This study compared costs and outcomes for coronary stenting versus percutaneous transluminal coronary angioplasty.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Health economics
Background:
- Coronary stent implantation reduces repeat revascularization but incurs higher initial costs than balloon angioplasty.
- Understanding the long-term cost-effectiveness of stenting is crucial for clinical practice.
Purpose of the Study:
- To compare the acute and one-year medical costs and patient outcomes of coronary stenting versus balloon angioplasty (percutaneous transluminal coronary angioplasty).
Main Methods:
- A comparative study of patients undergoing coronary stenting (n=384) or angioplasty (n=159) at Duke University.
- Detailed cost data were collected up to one year post-procedure.
- Primary analyses compared cumulative costs at six and 12 months, with sensitivity analyses adjusting for various factors.
Main Results:
- In-hospital costs were higher for stenting ($14,802) than angioplasty ($11,534).
- Stent patients had significantly lower rates of rehospitalization (22% vs. 34%) and repeat revascularization (9% vs. 26%) within six months.
- Mean cumulative costs at six months ($19,598 vs. $19,820) and one year ($22,140 vs. $22,571) were similar between the two groups.
Conclusions:
- Coronary stenting provides equivalent or superior one-year patient outcomes compared to balloon angioplasty.
- Coronary stenting does not increase cumulative healthcare costs in contemporary practice.
Objectives:
We compared the acute and one year medical costs and outcomes of coronary stenting with those for balloon angioplasty (percutaneous transluminal coronary angioplasty) in contemporary clinical practice.
Background:
While coronary stent implantation reduces the need for repeat revascularization, it has been associated with significantly higher acute costs compared with coronary angioplasty.
Methods:
We studied patients treated at Duke University between September 1995 and June 1996 who received either coronary stent (n = 384) or coronary angioplasty (n = 159) and met eligibility criteria. Detailed cost data were collected initially and up to one year following the procedure. Our primary analyses compared six and 12 month cumulative costs for coronary angioplasty- and stent-treated cohorts. We also compared treatment costs after excluding nontarget vessel interventions; after limiting analysis to those without prior revascularization; and after risk-adjusting cumulative cost estimates.
Results:
Baseline clinical characteristics were generally similar between the two treatment groups. The mean in-hospital cost for stent patients was $3,268 higher than for those receiving coronary angioplasty ($14,802 vs. $11,534, p < 0.001). However, stent patients were less likely to be rehospitalized (22% vs. 34%, p = 0.002) or to undergo repeat revascularization (9% vs. 26%, p = 0.001) than coronary angioplasty patients within six months of the procedure. As such, mean cumulative costs at 6 months ($19,598 vs. $19,820, p = 0.18) and one year ($22,140 vs. $22,571, p = 0.26) were similar for the two treatments. Adjusting for baseline predictors of cost and selectively examining target vessel revascularization, or those without prior coronary intervention yielded similar conclusions.
Conclusions:
In contemporary practice, coronary stenting provides equivalent or better one-year patient outcomes without increasing cumulative health care costs.