ECONOMICS OF ELECTIVE CORONARY REVASCULARIZATION - COMPARISON OF COSTS AND CHARGES FOR CONVENTIONAL ANGIOPLASTY, DIRECTIONAL ATHERECTOMY, STENTING AND BYPASS-SURGERY
ECONOMICS OF ELECTIVE CORONARY REVASCULARIZATION - COMPARISON OF COSTS AND CHARGES FOR CONVENTIONAL ANGIOPLASTY, DIRECTIONAL ATHERECTOMY, STENTING AND BYPASS-SURGERY
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DOI：
10.1016/0735-1097(93)90415-w
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发表时间：
1993-10-01
影响因子：
24
通讯作者：
BAIM, DS
中科院分区：
文献类型：
--
作者：
COHEN, DJ;BREALL, JA;BAIM, DS
目标。本研究旨在更密切地评估通过定向冠状动脉粥样硬化切除术和冠状动脉内支架植入术进行选择性血运重建术的真实住院成本，并将这些成本与传统血运重建术（即传统球囊血管成形术和冠状动脉搭桥手术）的成本进行比较。既往研究表明，定向冠状动脉粥样硬化切除术或冠状动脉内支架植入术的医院总费用明显高于常规血管成形术。然而，医院收费并不一定反映真实的经济成本，其使用可能会提供有关成本效益的误导性数据。我们分析了1990年1月1日至1991年12月31日期间300名接受选择性血管成形术、定向动脉粥样硬化切除术、Palmaz-Schatz冠状动脉支架置入或搭桥手术的患者的住院费用。然后，通过调整分项病人账户的特定部门的成本/收费比率，得出成本。导尿实验室费用以实际资源消耗为基础，每日房间费用根据所提供护理服务的强度进行调整。动脉粥样硬化切除术（2.3 +/- 1.5天）和常规血管成形术（2.6 +/- 1.7天）的住院时间相似，但支架植入术的住院时间明显更长（5.5 +/- 2.6天，p < 0.05）。冠脉支架植入术的总费用（7878 +/- 3270美元，中位数6699美元，p < 0.05）也显著高于血管成形术（5396 +/- 2829美元，中位数4753美元）或动脉粥样硬化切除术（5726 +/- 2716美元，中位数4986美元）。然而，搭桥手术的住院时间、资源消耗（如实验室和放射学检查、药物、血液制品）和总费用仍高于任何经皮介入手术。与以往仅使用医院费用的研究相比，血管成形术和定向冠状动脉粥样硬化切除术的住院费用相似。虽然冠状动脉支架植入术的费用比传统血管成形术大约高出2 500美元，但这一差异的幅度小于以前根据医院收费分析所建议的6 300美元的增加额。这些发现反映了基于成本和基于收费的方法之间的内在差异，可能对未来评估新型冠状动脉介入治疗的相对成本效益的研究具有重要意义。
Objectives. This study was designed to evaluate more closely the true in-hospital costs of elective revascularization by directional coronary atherectomy and intracoronary stenting and to compare these costs with those of the traditional revascularization alternatives (i.e., conventional balloon angioplasty and coronary artery bypass surgery).Background. Previous studies have suggested that total hospital charges for directional coronary atherectomy or intracoronary stenting are significantly higher than those for conventional angioplasty. However, hospital charges do not necessarily reflect true economic costs, and their use may provide misleading data with regard to cost-effectiveness.Methods. We analyzed in-hospital charges from the itemized hospital accounts of 300 patients undergoing elective angioplasty, directional atherectomy, Palmaz-Schatz coronary stenting or bypass surgery between January 1, 1990 and December 31, 1991. Costs were then derived by adjusting itemized patient accounts for department-specific cost/charge ratios. Catheterization laboratory costs were based on actual resource consumption, and daily room costs were adjusted for the intensity of nursing services provided.Results. Length of hospital stay was similar for atherectomy (2.3 +/- 1.5 days) and conventional angioplasty (2.6 +/- 1.7 days) but significantly longer for stenting (5.5 +/- 2.6 days, p < 0.05). Total costs were also significantly higher for coronary stenting ($7,878 +/- $3,270, median $6,699, p < 0.05) than for angioplasty ($5,396 +/- $2,829, median $4,753) or atherectomy ($5,726 +/- $2,716, median $4,986). However, length of stay, resource consumption (laboratory and radiologic testing, drugs, blood products, for example) and total costs for bypass surgery were still greater than for any of the percutaneous interventional procedures.Conclusions. In contrast to previous studies utilizing only hospital charges, the in-hospital costs of angioplasty and directional coronary atherectomy were similar. Although the cost of coronary stenting was approximately $2,500 higher than that of conventional angioplasty, the magnitude of this difference was smaller than the $6,300 increment previously suggested on the basis of analysis of hospital charges. These findings reflect the inherent discrepancies between cost-based and charge-based methodologies and may have important implications for future studies evaluating the relative cost-effectiveness of newer coronary interventions.