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Cost-effectiveness of coarctation repair strategies: endovascular stenting versus surgery
J C George1, D Shim, J C Bucuvalas
1The Heart Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
Insights
Stent implantation for coarctation of the aorta (CoA) is more cost-effective than surgical repair. This endovascular stent strategy offers significant savings in hospital costs and length of stay compared to traditional surgery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Economics
Background:
- Coarctation of the aorta (CoA) repair traditionally involves surgical intervention.
- The cost-effectiveness of endovascular stent (ST) implantation for CoA repair remains undocumented in medical literature.
Purpose of the Study:
- To evaluate the cost-effectiveness of stent (ST) implantation versus surgical (SU) repair for coarctation of the aorta (CoA).
Main Methods:
- Inflation-adjusted hospital costs were analyzed using the HBOC Cost Accounting System.
- Data included patients aged 5+ undergoing elective CoA repair between July 1997 and June 2001.
- Comparison between ST implantation (n=10) and surgical repair (n=12) groups.
Main Results:
- ST group had a significantly shorter hospital stay (0.8 days vs 3.5 days, p < 0.001) and lower mean cost ($7,148 vs $11,769, p < 0.005).
- ST implantation had a 10% failure rate, but cost-effectiveness remained superior until ST failure exceeded 39%.
- Successful repair with no residual systolic gradients at 1-year follow-up was achieved in both groups.
Conclusions:
- Endovascular stent repair for coarctation of the aorta is a cost-effective alternative to conventional surgical repair.
- The ST-first strategy demonstrates significant economic advantages and comparable clinical outcomes.
Abstract:
The cost-effectiveness of stent (ST) implantation for the repair of coarctation of the aorta (CoA) is not documented in the medical literature. Inflation-adjusted hospital costs for ST implantation and for surgical (SU) repair were obtained using the HBOC Cost Accounting System software and evaluated for all patients 5 years of age or older who underwent elective treatment of CoA between July 1997 and June 2001. The average age of the ST group (n = 10) to 9.5 +/- 3.5 years for the SU group (n = 12) (p > 0.10). The ST group had one failure due to inability to cross the CoA (failure rate, 10%). Successful repair was accomplished in all other ST cases and in all SU cases, with no residual systolic gradients at 1-year follow-up. Hospital length of stay for the ST group was 0.8 +/- 1.2 days compared to 3.5 +/- 0.5 days for the SU group (p < 0.001). The mean inflation-adjusted cost for the ST group was dollar 7,148 +/- 2,984 versus dollar 11,769 +/- 3,702 for the SU group (p < 0.005). By intention to treat analysis, the cost of repair in the ST-first group was dollar 8,325 +/- 3,354 given the 10% failure rate (p < 0.04 vs the SU only group). Sensitivity analysis demonstrates that cost of repair is lower with the ST-first strategy compared to SU only until the failure rate of ST implantation exceeds 39%. Repair of CoA using an endovascular stent strategy is cost-effective compared to conventional surgical repair.
