A COMPARISON OF THE COSTS OF AND QUALITY-OF-LIFE AFTER CORONARY ANGIOPLASTY OR CORONARY SURGERY FOR MULTIVESSEL CORONARY-ARTERY DISEASE - RESULTS FROM THE EMERY ANGIOPLASTY VERSUS SURGERY TRIAL (EAST)

Background The Emery Angioplasty Versus Surgery Trial (EAST) is a rand omized trial that compares, by intention to treat, the clinical outcom e and costs of percutaneous transluminal coronary angioplasty (PTCA) a nd coronary surgery for multivessel coronary artery disease. Methods a nd Results The primary end point was a composite of death, Q-wave myoc ardial infarction, and a large reversible thallium defect at 3 years. Multiple measures of quality of life also were made. Charges were asse ssed from the hospital UB-82 bills; professional charges were assessed from the Emery Clinic. Hospital charges were reduced to cost through step-down accounting methods. All costs and charges were deflated to 1 987 dollars. Costs were assessed for the initial hospitalization and t he cumulative costs of the initial hospitalization and additional reva scularization procedures for up to 3 years. There was no difference in mortality or the primary end point. Mean initial hospital charges wer e $12 654 for the PTCA group and $20 214 for the surgery group (P<.000 1). Professional charges were $4538 for PTCA and $9426 for surgery (P< .0001). Three-year hospital charges were $19 047 for PTCA and $21 174 for coronary surgery (P<.0001). Three-year professional charges were $ 6412 for PTCA and $9861 for surgery (P<.0001). Three-year total charge s were $25 458 for PTCA and $31 033 for surgery (P<.0001). Total 3-yea r costs were $23 734 for PTCA and $25 310 for coronary surgery (P<.000 1). There were more hospitalizations for angina and more antianginal m edications used in the PTCA group, which would further narrow the diff erences in cost. Conclusions There was no difference in the primary en d point or its components at 3 years. Although the primary procedural costs of coronary surgery are more than for coronary angioplasty, this cost advantage is largely, although probably not completely, lost by 3 years because of more frequent additional procedures and other resou rce consumption after a first revascularization by PTCA.