A one-year comparison of cost and outcomes of angioplasty in stent and nonstent patients.
Most studies on costs and outcomes of stent use in percutaneous transluminal coronary angioplasty (PTCA) have been limited to less than 1 year of follow-up, in-hospital costs, or regional samples. The objective of this study was to compare restenosis rates and all direct medical care costs during the 1-year period following stent PTCA and nonstent PTCA. A nationwide claims database covering 1.7 million lives was used to identify patients with PTCA during 1995 and no PTCA during the previous year. All costs and rate of restenotic events during the 1-year period following PTCA were examined. Symptomatic restenosis was defined as the occurrence of any of the following: repeat angioplasty, coronary artery bypass surgery (CABG), and myocardial infarction (MI). Stents were placed in 304 of 1367 identified patients. Both the rate of restenotic events (stent, 16.1%; no stent, 20.1%) and ischemic disease-related costs (stent, $9207; no stent, $10,498) were lower for patients with a stent during the follow-up period; however, the difference was not significant. Because of the higher cost of placing a stent during the initial procedure, patients with a stent had a significantly higher cost at the end of the 1-year period (stent, $49,245; stent, $40,683). Multivariate analyses further confirmed this finding. Thus, although restenotic events were lower for patients with stents by a nonsignificant margin, follow-up costs did not offset the higher cost of the initial stent placement.
Sen
Shuvayu S
SS
Merck & Co., Inc., Whitehouse Station, New Jersey 08889-0100, USA. shuvayu_sen@merck.com
Khandker
Rezaul K
RK
Roth
David A
DA
Thomas
Joseph
J
D000704:Analysis of Variance; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000191:economics*; D003324:Coronary Artery Disease / Q000191:economics* / Q000628:therapy*; D023903:Coronary Restenosis / Q000191:economics / Q000209:etiology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects / Q000191:economics*; D016896:Treatment Outcome