COST-EFFICACY MODELING OF CATHETER REUSE FOR PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Objectives. Our goal was to provide the range of cost savings associat ed with various catheter reuse strategies. Background. Percutaneous tr ansluminal coronary angioplasty catheters are commonly reused in sever al countries outside the United States. However, the cost-effectivenes s of such reuse strategies has not been evaluated. Methods. Three theo retical models of catheter reuse were constructed using the actual cos ts for treating patients with coronary angioplasty at the Cleveland Cl inic Costs were calculated based on the number of balloon catheters, t he amount of contrast agent used and the rates for urgent revasculariz ation that were observed in a prospective Canadian study on catheter r euse. Results. The median cost to treat a lesion by means of coronary angioplasty using new catheters was $8,800 per patient. In reuse model s, the potential to reduce cost depended on the number of balloon cath eters used and the rates of urgent revascularization. The ''best case' ' scenario offered a potential savings of $480 (5.5% of total in-hospi tal cost), whereas the ''worst case'' scenario resulted in an increase d cost of $1,075 (12.2% of total in-hospital cost) compared with the s ingle-use strategy, Cost of the ''likely case'' scenario was similar t o that of the single-use strategy. Sensitivity analyses identified the different rates of revascularization and cost of balloon catheters re quired to offset potential savings in each strategy. Conclusions. Alth ough reusing coronary angioplasty catheters may reduce total in-hospit al costs, even a modest increase in complications requiring urgent rev ascularization may offset any potential savings, However, if an increa se in complications and procedure time can be avoided, the reuse strat egy has significant economic potential and, ultimately, may be extende d to other percutaneous coronary interventional equipment.