COST-EFFECTIVENESS ANALYSIS OF STENTS, BALLOON ANGIOPLASTY, AND SURGERY FOR THE TREATMENT OF BRANCH PULMONARY-ARTERY STENOSIS

Branch pulmonary artery stenosis is a common problem in pediatric card iology. Treatment has included surgery, balloon angioplasty, and ballo on expand able stent placement. It was the purpose of this investigati on to demonstrate the cost-effectiveness of each of these modes of tre atment. From 1983 to 1994 there were 30 patients admitted for treatmen t of branch pulmonary artery stenosis only. Data included age at proce dure, sex, primary diagnosis, acute and intermediate term success, and complications. Acute success was defined by results at the end of the procedure where intermediate term (IT) success was defined by results at follow-up. Success of a procedure was defined by at least one of t he following: an increase in vessel diameter by greater than or equal to 50% of predilation diameter, a decrease in right ventricular to lef t ventricular or aortic systolic pressure ratio by greater than or equ al to 20%, or a decrease in peak to peak pressure gradient by greater than or equal to 50%. The procedure was considered a failure if the pr eviously mentioned criteria were not met or if the patient required a second procedure for the same stenosis. The expense of the procedure ( estimated by using the patient charges) were collected from the time o f the procedure until December 1994. Because of differing lengths of f ollow-up, the patients were analyzed separately for procedures and out patient charges. The total charges were corrected to 1994 dollars usin g the Medical Consumer Price Index. Thirty patients had 46 separate pr ocedures (12 patients had >1 procedure and 3 had >2 procedures). There were 13 surgeries, 13 balloon angioplasties, and 20 stents. Stents we re the most successful (90% acute and 85% IT), but were not statistica lly superior to surgery (62% acute and IT). Balloon angioplasty was si gnificantly less successful as compared with stents (31% acute and 23% IT), and was not statistically different from surgery over the acute and intermediate term. The charge data showed balloon angioplasty was the least expensive followed by stents and then by surgery. The averag e total charges per procedure, including outpatient charges, were: sur gery $58,068 +/- $4372 (standard error), balloon $21,893 +/- $5019, st ents $33,809 +/- $3533 (p < 0.001); excluding outpatient charges: surg ery $52,989 +/- $3649, balloon $15,653 +/- $1691, and stents $29,531 /- $2241 (p < 0.001). Average total charges per patient, including all procedure types and grouped by initial procedure, were: surgery $53,7 07 +/- $6388, balloon $50,040 +/- $8412, and stent $34,346 +/- $3488 ( p = 0.047). Stents were at least as effective as surgery and were more effective than balloon angioplasty in both acute and intermediate ter m follow-up. Balloon angioplasty was least expensive per procedure but was also least effective. Therefore, intravascular balloon expandable stents are the most cost-effective means available in the treatment o f branch pulmonary artery stenosis.