Richard B. Siegrist

In-Hospital and One-Year Economic Outcomes After Coronary Stenting or Balloon Angioplasty Results From a Randomized Clinical Trial

BACKGROUND Coronary stenting has been shown to improve initial success, reduce angiographic restenosis, and reduce the need for repeat revascularization compared with conventional balloon angioplasty (PTCA). Although previous studies have demonstrated that initial hospital costs for stenting are considerably higher than those for conventional PTCA, the impact of coronary stenting on long-term medical care costs remains unknown. METHODS AND RESULTS Between January 1991 and June 1993, 207 consecutive patients with symptomatic coronary disease requiring revascularization of a single coronary lesion were randomized to receive initial treatment by either PTCA (n = 105) or Palmaz-Schatz coronary stent implantation (n = 102) in the multicenter STRESS trial. Detailed resource utilization and cost data were collected for each patients initial hospitalization and for any subsequent hospital visits for 1 year after randomization. Compared with conventional angioplasty, coronary stenting resulted in additional catheterization laboratory costs, increased vascular complications, and longer length of stay. Initial hospital costs were thus approximately

Operating-room throughput: strategies for improvement.

2200 higher for stenting than for PTCA (

Patient Satisfaction: History, Myths, and Misperceptions

9738 +/- 3248 versus

Age and laboratory costs for hospitalized medical patients.

7505 +/- 5015; P < .001). Over the first year of follow-up, however, patients assigned to initial stenting were less likely to require rehospitalization for a cardiac condition and underwent fewer subsequent revascularization procedures. Follow-up medical care costs thus tended to be lower for stenting than for conventional angioplasty (

Financial and Operational Analysis of Non–Operating Room Anesthesia: the Wrong Way Versus the Right Way

1918 +/- 4841 versus

The ratio of costs to charges: how good a basis for estimating costs?

3359 +/- 7100, P = .21). Nonetheless, cumulative 1-year medical care costs remained higher for patients undergoing initial stenting (

Comparison of analytic approaches for the economic evaluation of new technologies alongside multicenter clinical trials

11,656 +/- 5674 versus

Understanding Rising Hospital Inpatient Costs: Key Components of Cost and The Impact of Poor Quality

10,865 +/- 9073, P < .001). Even after adjustment for the higher incidence of vascular complications in the stent group, total 1-year costs were

Exploring the relationship between inpatient hospital costs and quality of care.

300 higher for stenting than for balloon angioplasty. CONCLUSIONS Elective coronary stenting, as performed in the randomized STRESS trial, increased total 1-year medical care costs by approximately

Improving patient flow in the cath lab.

800 per patient compared with conventional angioplasty. Future studies will be necessary to determine whether ongoing refinements in stent design, implantation techniques, and anticoagulation regimens can narrow this cost difference further by reducing stent-related vascular complications or length of stay.