Economic outcomes analysis of stenting versus percutaneous transluminal coronary angioplasty for patients with coronary artery disease in Japan.
The purpose of this study was to compare the clinical outcomes and costs of coronary stenting with conventional percutaneous transluminal coronary angioplasty (PTCA) in patients with coronary artery disease (CAD) in Japan. The increasing use of stent implantation in CAD has raised economic concerns for healthcare decision makers. This decision analysis model, which applies to the Japanese healthcare system and uses recent clinical and economic data, demonstrates coronary stenting to be superior to PTCA, both in terms of effectiveness and cost. Although the procedural costs for the stenting group are substantially higher than for PTCA (1,233,412 yen versus 709,295 yen, respectively; p<0.001), the difference in cost between the two procedures (524,117 yen) is already reduced to 299,408 yen by the time of hospital discharge due to procedural complications and associated bail-out treatments avoided during the in-hospital period. The initial incremental cost of stenting is more than recouped by the end of year one, mainly because of savings realized due to avoided repeat revascularization procedures. The cost neutrality (or small cost saving) is maintained over subsequent years. Thus, coronary artery stenting leads to better results as well as cost neutrality after one, two and three years. This highly desirable outcome implies that stenting rather than PTCA alone should be the treatment of choice and dominant strategy in Japan from the viewpoint of both the patient and the healthcare system.
Ikeda
S
S
Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan.
Bosch
J
J
Banz
K
K
Schneller
P
P
D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D003327:Coronary Disease / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D006801:Humans; D007564:Japan / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D015607:Stents / Q000191:economics*