Costs of revascularization over eight years in the randomized and eligiblepatients in the Emory Angioplasty versus Surgery Trial (EAST)

The Emery Angioplasty versus Surgery Trial (EAST) was a randomized trial th at compared, by intention to treat, the clinical outcome and costs of percu taneous transluminal coronary angioplasty (PTCA) and coronary bypass grafti ng (CABG) for multivessel coronary artery disease. We present the findings of the economic analysis of EAST through 8 years of follow-up and compare t he cost and outcomes of patients randomized in EAST versus patients eligibl e but not randomized (registry patients). Charges were assessed from hospit al UB82 and UB92 bills and professional charges from the Emery Clinic. Hosp ital charges were reduced to cost through step-down accounting methods. All costs and charges were inflated to 1997 dollars. Costs were assessed for i nitial hospitalization and for cumulative costs of the initial hospitalizat ion and additional revascularization procedures up to 8 years. Total 8-year costs were $46,548 for CABG and $44,491 for PTCA (p = 0.37), Cost of CABG in the eligible registry group showed a pattern similar to that for randomi zed patients, but total cost of PTCA was lower for registry patients than f or randomized patients, Thus, the primary procedural costs of CABG are more than those for PTCA; this cost advantage, given the limits of measurement, is largely or even completely lost for randomized patients over the course of 8 years because of additional procedures after a first revascularizatio n by PTCA, (C) 2000 by Excerpta Medica, Inc.