In-hospital costs associated with new percutaneous coronary devices.
To determine the relative economic impact of alternative methods of coronary revascularization, in-hospital patient accounts were reviewed in 149 patients undergoing elective coronary angioplasty (n = 50), coronary atherectomy (n = 72) or intracoronary stent placement (n = 27) over an 18-month period. Clinical and angiographic features were similar in the 3 groups, except that prior restenosis was seen more often in patients undergoing intracoronary stent placement. Procedural success, obtained in greater than 90% of patients, was independent of the treatment strategy. Total in-hospital stay was significantly longer in patients undergoing intracoronary stent placement than in patients undergoing coronary angioplasty and directional atherectomy (4.9 +/- 2.4 days vs 1.5 +/- 1.3 and 2.2 +/- 3.9 days, respectively; p less than 0.0001). Furthermore, the total in-hospital charges were significantly higher in patients undergoing intracoronary stent placement ($12,574 +/- $4,564 vs $6,220 +/- $5,716; p less than 0.001) and directional atherectomy ($8,329 +/- $8,588 vs $6,220 +/- $5,716; p less than 0.01) than in patients undergoing coronary angioplasty, reflecting overall differences in room costs, laboratory fees and pharmacy fees. The longer in-hospital stay in the intracoronary stent group was primarily attributed to the time required for anticoagulation with coumadin. It is concluded that a 102 and 34% increase in early hospital charges resulted with stenting or directional atherectomy, respectively, compared with coronary angioplasty. These increased in-hospital charges were chiefly due to the prolonged hospitalization time, device cost, laboratory fees and, in patients with intracoronary stents, the prolonged time needed to achieve systemic anticoagulation.
Department of Internal Medicine (Cardiology Division), University of Michigan Medical Center, Ann Arbor 48109-0022.
R J
RJ
Dick
J J
JJ
Popma
D W
DW
Muller
K A
KA
Burek
E J
EJ
Topol
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000295:instrumentation; D016507:Cardiology Service, Hospital / Q000191:economics*; D002404:Catheterization / Q000191:economics* / Q000295:instrumentation; D003327:Coronary Disease / Q000191:economics / Q000601:surgery / Q000628:therapy*; D003331:Coronary Vessels / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D015607:Stents / Q000191:economics*