Acute and long-term cost implications of coronary stenting

OBJECTIVES We compared the acute and one year medical costs and outcomes of coronary stenting with those for balloon angioplasty (percutaneous translu minal coronary angioplasty) in contemporary clinical practice. BACKGROUND While coronary stent implantation reduces the need for repeat re vascularization, it has been associated with Significantly higher acute cos ts compared with coronary angioplasty. METHODS We studied patients treated at Duke University between September 19 95 and June 1996 who received either coronary stent (n = 384) or coronary a ngioplasty(n = 159) and met eligibility criteria. Detailed cost data were c ollected initially and up to one year following the procedure. Our primary analyses compared six and 12 month cumulative costs for coronary angioplast y-and stent-treated cohorts. We also compared treatment costs after excludi ng nontarget vessel interventions; after limiting analysis to those without prior revascularization; and:after risk-adjusting cumulative cost estimate s. RESULTS Baseline clinical characteristics Were generally similar between the two treatment groups. The mean in-hospital cost for stent patients was $3,268 higher than for those receiving coronary angioplasty ($14,802 vs. $ 11,534, p < 0.001). However, stent patients were less likely to be rehospit alized (22% vs. 34%, p = 0.002) or to undergo repeat revascularization (9% vs. 26%, p = 0.001) than coronary angioplasty patients within six months of the procedure. As such, mean cumulative costs at 6 months ($19,598 vs. $19 ,820, p = 0.18) and one year ($22,140 vs. $22,571, p = 0.26) were similar f or the two treatments. Adjusting for baseline predictors of cost and select ively examining target vessel revascularization, or those without prior cor onary intervention yielded similar conclusions. CONCLUSIONS In contemporary practice, coronary Stenting provides equivalent or better one-year patient Outcomes without increasing cumulative health c are costs. (C) 1999 by the American College of Cardiology.