ECONOMICS OF ELECTIVE CORONARY REVASCULARIZATION - COMPARISON OF COSTS AND CHARGES FOR CONVENTIONAL ANGIOPLASTY, DIRECTIONAL ATHERECTOMY, STENTING AND BYPASS-SURGERY

Objectives. This study was designed to evaluate more closely the true in-hospital costs of elective revascularization by directional coronar y atherectomy and intracoronary stenting and to compare these costs wi th those of the traditional revascularization alternatives (i.e., conv entional balloon angioplasty and coronary artery bypass surgery). Back ground. Previous studies have suggested that total hospital charges fo r directional coronary atherectomy or intracoronary stenting are signi ficantly higher than those for conventional angioplasty. However, hosp ital charges do not necessarily reflect true economic costs, and their use may provide misleading data with regard to cost-effectiveness. Me thods. We analyzed in-hospital charges from the itemized hospital acco unts of 300 patients undergoing elective angioplasty, directional athe rectomy, Palmaz-Schatz coronary stenting or bypass surgery between Jan uary 1, 1990 and December 31, 1991. Costs were then derived by adjusti ng itemized patient accounts for department-specific cost/charge ratio s. Catheterization laboratory costs were based on actual resource cons umption, and daily room costs were adjusted for the intensity of nursi ng services provided. Results. Length of hospital stay was similar for atherectomy (2.3 +/- 1.5 days) and conventional angioplasty (2.6 +/- 1.7 days) but significantly longer for stenting (5.5 +/- 2.6 days, p < 0.05). Total costs were also significantly higher for coronary stenti ng ($7,878 +/- $3,270, median $6,699, p < 0.05) than for angioplasty ( $5,396 +/- $2,829, median $4,753) or atherectomy ($5,726 +/- $2,716, m edian $4,986). However, length of stay, resource consumption (laborato ry and radiologic testing, drugs, blood products, for example) and tot al costs for bypass surgery were still greater than for any of the per cutaneous interventional procedures. Conclusions. In contrast to previ ous studies utilizing only hospital charges, the in-hospital costs of angioplasty and directional coronary atherectomy were similar. Althoug h the cost of coronary stenting was approximately $2,500 higher than t hat of conventional angioplasty, the magnitude of this difference was smaller than the $6,300 increment previously suggested on the basis of analysis of hospital charges. These findings reflect the inherent dis crepancies between cost-based and charge-based methodologies and may h ave important implications for future studies evaluating the relative cost-effectiveness of newer coronary interventions.