A comparison of patient charges associated with percutaneous transluminal coronary angioplasty and coronary artery bypass grafting.
Appropriate interventional treatment for coronary artery disease is an important component in controlling health care expenditures. We conducted a retrospective study to compare the patient charges associated with percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). All patients underwent treatment for left anterior descending coronary artery stenosis over a 3 year 9 month time period from March 1987 to December 1990 and were followed for 7-58 months (median 43 months) after treatment. The two groups were constructed in such a way that they were balanced for common vessels diseased, number of vessels diseased, sex, age, and ejection fraction (EF). The study included 26 PTCA patients between the ages of 33 and 86 years, 18 males and eight females, with a mean EF of 58 per cent, and 26 CABG patients from 39 to 80 years of age, 18 males and 8 females, with a mean EF of 61 per cent. Charges were categorized as to hospital, professional, cardiac medication, follow-up, and total costs. While CABG was initially more expensive, nine of the PTCA patients (38%) required further interventional treatment (3 PTCA, 5 CABG, 1 PTCA and CABG), whereas none of the CABG patients required further intervention (P < .001). This short-term follow-up demonstrated, that although initially less expensive, repeat interventional charges are significantly higher in PTCA patients. With the escalating costs of health care, the appropriate initial interventional therapy for coronary artery disease must be carefully selected to reduce long-term health care expenses.
Walls
J T
JT
Division of Cardiothoracic Surgery, University of Missouri, Columbia.
Boley
T M
TM
Rives
L
L
Koenig
S
S
Curtis
J J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D001026:Coronary Artery Bypass / Q000191:economics*; D003327:Coronary Disease / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology; D005249:Fees and Charges; D005251:Fees, Medical; D005252:Fees, Pharmaceutical; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology