title: Cost-effectiveness of coarctation repair strategies: endovascular stenting versus surgery.
abstract: The cost-effectiveness of stent (ST) implantation for the repair of coarctation of the aorta (CoA) is not documented in the medical literature. Inflation-adjusted hospital costs for ST implantation and for surgical (SU) repair were obtained using the HBOC Cost Accounting System software and evaluated for all patients 5 years of age or older who underwent elective treatment of CoA between July 1997 and June 2001. The average age of the ST group (n = 10) to 9.5 +/- 3.5 years for the SU group (n = 12) (p > 0.10). The ST group had one failure due to inability to cross the CoA (failure rate, 10%). Successful repair was accomplished in all other ST cases and in all SU cases, with no residual systolic gradients at 1-year follow-up. Hospital length of stay for the ST group was 0.8 +/- 1.2 days compared to 3.5 +/- 0.5 days for the SU group (p < 0.001). The mean inflation-adjusted cost for the ST group was dollar 7,148 +/- 2,984 versus dollar 11,769 +/- 3,702 for the SU group (p < 0.005). By intention to treat analysis, the cost of repair in the ST-first group was dollar 8,325 +/- 3,354 given the 10% failure rate (p < 0.04 vs the SU only group). Sensitivity analysis demonstrates that cost of repair is lower with the ST-first strategy compared to SU only until the failure rate of ST implantation exceeds 39%. Repair of CoA using an endovascular stent strategy is cost-effective compared to conventional surgical repair.
authors.affiliation: The Heart Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: George
authors.forename: D
authors.initials: D
authors.lastname: Shim
authors.forename: J C
authors.initials: JC
authors.lastname: Bucuvalas
authors.forename: E
authors.initials: E
authors.lastname: Immerman
authors.forename: P B
authors.initials: PB
authors.lastname: Manning
authors.forename: J M
authors.initials: JM
authors.lastname: Pearl
authors.forename: R H
authors.initials: RH
authors.lastname: Beekman
mesh_terms: D000293:Adolescent; D001017:Aortic Coarctation / Q000191:economics / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D014656:Vascular Surgical Procedures / Q000191:economics*