IN-HOSPITAL AND ONE-YEAR ECONOMIC OUTCOMES AFTER CORONARY STENTING ORBALLOON ANGIOPLASTY - RESULTS FROM A RANDOMIZED CLINICAL-TRIAL

Background Coronary stenting has been shown to improve initial success , reduce angiographic restenosis, and reduce the need for repeat revas cularization compared with conventional balloon angioplasty (PTCA). Al though previous studies have demonstrated that initial hospital costs for stenting are considerably higher than those for conventional PTCA, the impact of coronary stenting on long-term medical care costs remai ns unknown. Methods and Results Between January 1991 and June 1993, 20 7 consecutive patients with symptomatic coronary disease requiring rev ascularization of a single coronary lesion were randomized to receive initial treatment by either PTCA (n=105) or Palmaz-Schatz coronary ste nt implantation (n=102) in the multicenter STRESS trial. Detailed reso urce utilization and cost data were collected for each patient's initi al hospitalization and for any subsequent hospital visits for 1 year a fter randomization. Compared with conventional angioplasty, coronary s tenting resulted in additional catheterization laboratory costs, incre ased vascular complications, and longer length of stay. Initial hospit al costs were thus approximate to$2200 higher for stenting than for PT CA ($9738+/-3248 versus $7505+/-5015; P<.001). Over the first year of follow-up, however, patients assigned to initial stenting were less li kely to require rehospitalization for a cardiac condition and underwen t fewer subsequent revascularization procedures. Follow-up medical car e costs thus tended to be lower for stenting than for conventional ang ioplasty ($1988+/-4841 versus $3359+/-7100, P=.21). None theless, cumu lative 1-year medical care costs remained higher for patients undergoi ng initial stenting ($11 656+/-5674 versus $10 865+/-9073, P<.011). Ev en after adjustment for the higher incidence of vascular complications in the stent group, total 1-year costs were $300 higher for stenting than for balloon angioplasty. Conclusions Elective coronary stenting, as performed in the randomized STRESS trial, increased total 1-year me dical care costs by approximate to$800 per patient compared with conve ntional angioplasty. Future studies will be necessary to determine whe ther ongoing refinements in stent design, implantation techniques, and anticoagulation regimens can narrow this cost difference further by r educing stent-related vascular complications or length of stay.