Hospitalization costs of primary stenting versus thrombolysis in acute myocardial infarction: cost analysis of the Canadian STAT Study.
BACKGROUND
We previously showed that primary stenting was more effective than accelerated tPA in reducing the 6-month composite of death, reinfarction, stroke, or repeat revascularization for ischemia. This study looks at the hospitalization costs of primary stenting compared with accelerated tPA.


RESULTS
Initial and 6-month hospitalization costs were computed for all patients randomly assigned to primary stenting (n=62) or accelerated tPA (n=61) in the Stenting versus Thrombolysis in Acute myocardial infarction Trial (STAT). Costs and resource usage were collected in detail for each patient. Physician fees were obtained directly from billings to the Ontario Health Insurance Plan. The length of initial hospitalization was 6.7+/-11.3 days in the stent group and 8.7+/-6.7 days in the tPA group (P<0.001). Total hospitalization days at 6 months were 8.3+/-13 days in the stent group and 12.1+/-14.0 days in the tPA group (P=0.001). Hospitalization costs were less in the stent group for the initial hospitalization, 6354 dollars +/-6382 versus 7893 dollars +/-4429 (P=0.001), and at 6 months, 7100 dollars +/-7111 versus 9559 dollars +/-6933 (P=0.001).


CONCLUSIONS
In centers in which facilities and experienced interventionists are available, primary stenting is less costly and more effective than thrombolysis.
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada. mlemay@ottawaheart.ca
Michel R
MR
Le May
Richard F
RF
Davies
Marino
M
Labinaz
Heather
H
Sherrard
Jean-François
JF
Marquis
Louise A
LA
Laramée
Edward R
ER
O'Brien
William L
WL
Williams
Rob S
RS
Beanlands
Graham
G
Nichol
Lyall A
LA
Higginson
D002170:Canada; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000191:economics / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D015607:Stents / Q000191:economics* / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000191:economics* / Q000706:statistics & numerical data; D010959:Tissue Plasminogen Activator / Q000191:economics / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator