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Cost analysis between stent and conventional balloon angioplasty
Y Kobayashi1, J De Gregorio, Y Yamamoto
1Division of Interventional Cardiology, Lenox Hill Hospital, New York, USA.
Insights
Coronary stenting is more expensive than balloon angioplasty due to higher device costs, despite lower revascularization rates. The overall cost difference between stenting and balloon angioplasty is not fully offset by reduced follow-up procedures.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Coronary artery disease management often involves percutaneous coronary intervention.
- Comparing the economic implications of different revascularization strategies is crucial for healthcare resource allocation.
Purpose of the Study:
- To evaluate and compare the costs associated with coronary stenting versus conventional balloon angioplasty in Japan.
- To analyze the cost-effectiveness of stenting considering procedural and follow-up expenses.
Main Methods:
- Cost estimation included procedural fees, device costs (stents, balloons), hospital stay (7 days), and diagnostic tests.
- Data from the Stent Restenosis Study (STRESS) on device usage and target lesion revascularization (TLR) rates were utilized.
- Follow-up costs were calculated based on differential TLR rates (21% for balloon angioplasty, 15% for stenting).
Main Results:
- In-hospital costs were higher for stenting (Yen 1,416,893) compared to balloon angioplasty (Yen 982,300).
- Overall costs, including follow-up, were Yen 1,564,238 for stenting and Yen 1,188,583 for balloon angioplasty.
- Higher initial device costs for stenting contributed significantly to its increased expense, partially offset by lower revascularization rates.
Conclusions:
- Coronary stenting incurs higher in-hospital costs than conventional balloon angioplasty, primarily due to device expenses.
- While lower target lesion revascularization rates for stenting reduce long-term costs, the initial higher expenditure is not fully compensated.
- Economic considerations remain important when selecting between coronary stenting and balloon angioplasty in Japan.
Abstract:
The present study evaluated the cost of coronary stenting compared with conventional balloon angioplasty in Japan. Procedural cost was estimated as the sum of the procedural fee and the cost of devices such as angioplasty balloon and stent. The data such as the number of balloon catheters and stents used, and the rate of crossovers that was shown by the Stent Restenosis Study (STRESS) were applied to calculate the costs of stenting and conventional balloon angioplasty. For the estimation of hospital room and nursing costs, the length of the in-hospital stay was estimated at 7 days. The costs of procedures such as laboratory and radiological tests were determined based on routine coronary intervention at Chiba University Hospital. The rates of target lesion revascularization in the STRESS trial (conventional balloon angioplasty: 21%, stenting: 15%) were used to calculate the cost during follow up. The in-hospital costs of conventional balloon angioplasty and stenting were estimated to be Yens 982,300 and Yens 1,416,893, respectively. The overall costs, including follow-up cost, of conventional balloon angioplasty and stenting were estimated to be Yens 1,188,583 and Yens 1,564,238, respectively. The in-hospital cost of stenting is higher compared with conventional balloon angioplasty because of greater balloon use and direct stent cost. Lower target lesion revascularization reduces the cost difference between conventional balloon angioplasty and stenting, but the higher initial cost of stenting is not fully offset.