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Resource use and cost of initial coronary revascularization. Coronary angioplasty versus coronary bypass surgery
M A Hlatky1, J Lipscomb, C Nelson
1Department of Medicine, Duke University Medical Center, Durham, NC.
Insights
Comparing coronary artery bypass graft surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA), actual economic costs show significantly lower savings than hospital charges suggest. Careful cost-accounting is crucial for accurate financial analysis.
Area of Science:
- Health Economics
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Intense interest exists in the cost-saving potential of therapeutic alternatives in healthcare.
- Most prior studies have relied on hospital charges, not actual economic costs, for analysis.
- Accurate cost assessment is vital for evaluating the economic viability of different medical procedures.
Purpose of the Study:
- To rigorously analyze and compare the economic costs of coronary artery bypass graft surgery (CABG) versus percutaneous transluminal coronary angioplasty (PTCA).
- To estimate the actual cost savings achievable by switching patients from CABG to PTCA.
- To highlight the discrepancy between hospital charges and true economic costs in procedural comparisons.
Main Methods:
- Studied 115 patients undergoing initial elective PTCA and 274 patients undergoing initial elective CABG.
- Constructed detailed resource consumption profiles for each procedure.
- Applied four distinct cost-accounting methods with varying assumptions on fixed and variable costs.
Main Results:
- Mean hospital charges for CABG ($19,644) were significantly higher than for PTCA ($9,556) (p < 0.0001).
- Estimated economic cost differences between CABG and PTCA were substantially less than the difference in charges.
- Net savings using four cost-accounting methods ranged from 19% to 78% of charges, indicating overestimation by charge data.
Conclusions:
- Initial hospital charges for PTCA are significantly lower than for CABG.
- Actual economic cost savings of PTCA over CABG can be significantly overestimated when relying solely on hospital charge data.
- The study underscores the necessity of employing robust cost-accounting methodologies for accurate financial evaluations in healthcare.
Abstract:
Although there is intense interest in the cost-saving potential of therapeutic alternatives, most studies have analyzed hospital charges rather than actual economic costs. To analyze cost differences rigorously, we studied 115 patients undergoing initial elective angioplasty (percutaneous transluminal coronary angioplasty, PTCA) and 274 patients undergoing initial elective surgery (coronary artery bypass graft surgery, CABG). Detailed resource consumption profiles were constructed and used to estimate the cost savings from switching a patient from CABG to PTCA. Four cost-accounting methods were used in the analysis; each method made different assumptions about the costs that would vary and the costs that would be fixed according to the number of procedures performed. The variable costs in the four methods were the 1) cost of supplies, 2) cost of personnel and supplies, 3) average direct costs, and 4) average direct costs plus allocated hospital overhead. The mean hospital charges for CABG patients were $19,644 versus $9,556 for PTCA patients (p less than 0.0001). The estimated cost difference between CABG and PTCA was substantially less than the $10,088 difference in charges, however, with net savings of 19%, 46%, 53%, and 78% of charges using cost-accounting methods 1-4, respectively. Thus, although the initial hospital charges for PTCA are significantly less than for CABG, the actual economic cost savings may be significantly overestimated by the use of hospital charge data.