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[Is coronary angioplasty less costly than aortocoronary bypass?]
M Casaccia1, S Marra, G M Ottino
1Divisione Ospedaliera di Cardiologia, Ospedale Maggiore di San Giovanni Battista, Torino.
Insights
Percutaneous coronary angioplasty (PTCA) is initially more cost-effective than coronary artery bypass grafting (CABG). While complications and follow-up reduce PTCA
Area of Science:
- Cardiovascular Medicine
- Health Economics
Context:
- Retrospective comparison of two major coronary revascularization procedures.
- Analysis of cost-benefit ratio for coronary bypass grafting (CABG) and percutaneous coronary angioplasty (PTCA).
- Inclusion of 40 patients for each procedure with at least 1-year follow-up.
Purpose:
- To compare the cost-benefit ratio of CABG versus PTCA.
- To analyze various cost components including real estate, medical products, drugs, hospital charges, fees, and tests.
- To evaluate the impact of complications and long-term follow-up on the cost-effectiveness of each procedure.
Summary:
- Initial total cost of CABG was 1.64 times higher than PTCA (15,095,000 vs 9,201,346 Italian Liras).
- Considering complications, the cost difference narrowed to a factor of 1.39 (15,746,500 vs 11,323,000 ILit).
- After 1-year follow-up, the cost factor decreased to 1.18 (16,613,500 vs 14,027,500 ILit), with PTCA patients experiencing shorter hospital stays, earlier return to work, and reduced psychosocial stress.
Impact:
- PTCA offers initial cost savings compared to CABG.
- The economic advantage of PTCA diminishes when complications and long-term outcomes are factored in.
- PTCA provides significant benefits in terms of patient recovery and quality of life, including shorter hospitalization and earlier return to work.
Abstract:
We retrospectively compared the cost-benefit ratio of coronary bypass grafting (CABG) and percutaneous coronary angioplasty (PTCA). Data were obtained on 40 CABG's and 40 PTCA's patients treated from 15/2/86 to 15/9/86. All patients had at last 1-year follow-up. PTCA and CABG groups had similar baseline clinical and angiographic criteria. We analyzed the following cost components: real estate, biomedical products, drugs, hospital charges, medical fees, cardiac and non-cardiac tests. Total cost of CABG exceeds that of PTCA by a factor of 1.64: 15,095,000 vs 9,201,346 Italian liras (ILit). Taking into account early and late medical and surgical complications, the factor decreases to 1.39: 15,746,500 vs 11,323,000 ILit. After 1 year of follow-up the factor decreases to 1.18: 16,613,500 vs 14,027,500 ILit. Our data show that the initial savings were reduced when complications and follow-up are considered, but PTCA's patients had shorter hospitalization, earlier return to work, lower psychosocial stress.