CLINICAL STUDIES
Acute and long-term cost implications of coronary stenting
Eric D. Peterson, MD, MPH, FACC*,
Patricia A. Cowper, PhD ,
Elizabeth R. DeLong, PhD,
James P. Zidar, MD, FACC*,
Richard S. Stack, MD, FACC* and
Daniel B. Mark, MD, MPH, FACC*
* Division of Cardiology, Department of Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA and
the Division of Biometry, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
Manuscript received July 28, 1998;
revised manuscript received January 5, 1999,
accepted January 20, 1999.
Reprint requests and correspondence: Dr. Eric D. Peterson, Box 3236, Duke University Medical Center, Durham, North Carolina 27710
peter016{at}mc.duke.edu
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.
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Abbreviations and Acronyms
| | ACT | = activated clotting time | | CCS | = Canadian Cardiovascular Society | | COPD | = chronic obstructive pulmonary disease | | ICU | = intensive care unit | | IVUS | = intravascular ultrasound | | LAD | = left anterior descending artery | | MI | = myocardial infarction |
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