COST-ANALYSIS OF CURRENT THERAPIES FOR LIMITED CORONARY-ARTERY REVASCULARIZATION

Background Single or double (limited) coronary artery revascularizatio n using percutaneous transluminal coronary angioplasty (PTCA) and coro nary artery bypass (CAB) surgery has recently been enhanced with furth er innovation in intracoronary stenting and the emergence of minimally invasive direct coronary artery bypass (MIDCAB) grafting. Resource al location for all modalities is directly dependent on hospitalization c osts, length of stay, and clinical results. Methods and Results Four g roups of 25 consecutive patients over 9 months at a single center rece ived either PTCA, stenting, MIDCAB, or conventional CAB for single-ves sel coronary disease, primarily of the left anterior descending circul ation. Day, supply, and procedural charges were evaluated, along with the total hospital charge. Postprocedural length of stay was calculate d and compared with a national database. MIDCAB surgery day charges we re less than stenting but greater than PTCA, MIDCAB supply charges wer e the least of all groups, and MIDCAB procedural charges were less tha n for conventional CAB. Total charges for MIDCAB grafting were less th an for stenting but greater than for PTCA. Postprocedural length of st ay for MIDCAB patients was equivalent to PTCA patients and significant ly less than for stenting or for conventional CAB. Conclusions MIDCAB grafting provides a new surgical approach that is comparable in charge s to catheter-based interventions. The technique markedly reduces leng th of slay and perioperative morbidity. The selection of medical or su rgical limited coronary revascularization can now be based primarily o n clinical outcomes without consideration for associated resource allo cation.