Impact of an aggressive stenting strategy on initial and one-year follow-up costs ire patients undergoing coronary angioplasty

Background: Although stents have been shown in randomised trials to reduce restenosis rates compared with balloon angioplasty, there are concerns rega rding the cost-effectiveness of an aggressive stenting strategy. Stents wer e shown to increase medical costs over 12 months in the early trials. Aim: Our aim was to determine the economic impact of an aggressive stenting strategy using current stenting techniques compared with a conservative st enting strategy. Methods: Initial and one year follow-up costs were determined in all patien ts who underwent successful revascularisation during June to December 1996 (aggressive stenting, n = 401), and compared to all patients treated in the corresponding months in 1995 (conservative stenting, n = 347). All patient s had clinical follow-up for one year. Results: The proportion of patients receiving a stent increased from 22.5% in 1995 to 66.1% in 1996 (p < 0.0001). Requirement for repeat procedures in the 1995 group compared with 1996 was coronary angiography in 31% vs 16% ( p < 0.0001), coronary angioplasty in 11% vs 6% (p = 0.0044) and bypass surg ery in 4.8% vs 2.5% (p = 0.054). The mean initial cost of the procedure was higher in the aggressive stenting group ($4319 +/- 1276 in 1995 vs $5131 /- 1491 in 1996, p < 0.0001), but after 12 months followup, total medical c osts were equivalent ($5975 +/- 4143 in 1995 vs $5994 +/- 3476 in 1996, p = NS). Conclusion: An aggressive coronary stenting strategy is associated with hig her initial costs compared with a conservative strategy, but lower costs du ring follow-up due to reduced need for repeat procedures, resulting in equi valent one year total medical costs.