Cost‐effectiveness of coronary angioplasty versus medical treatment: the impact of cost‐shifting

Abstract

From society's perspective, PTCA may be more cost-effective than a medical strategy. However, the financial interests of the hospital are best served by limiting PTCA or restricting PTCA to privately insured patients. Cost-shifting may have a major impact on the provision of PTCA. The costs of providing medical services need to be weighed against the cost of not providing them.

Comparing systems for costing hospital treatments

“…[17] US$ 9556 Total hospitalisation Hout et al [18] fl 13994 (US$ 7774) Hospitalisation receiving a PCI King et al [19] US$ 9113 PCI procedure and following periods of hospitalisation King et al [20] US$ 11684 PCI procedure and following periods of hospitalisation Kinlay [21] US$ 10930…”

Treatment for Stable Coronary Artery Disease: A Network Meta-Analysis of Cost-Effectiveness Studies

“…We identified 15 RCT with 18 articles and two oral communications presented at major medical congresses that met our inclusion criteria (Figure 1): ACME [26] ( The Veterans Affairs Cooperative Study: Angioplasty Compared to Medicine ), ARTS [27], [28] ( Arterial Revascularization Therapy Study ), BENESTENT II [29] ( Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease ), COURAGE [14] ( Optimal Medical Therapy with or without PCI for Stable Coronary Disease ), EAST [30] ( Emory Angioplasty Versus Surgery Trial ), ENDEAVOR II [12], [31]–[33] ( Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions ), ERACI [34], [35] ( Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease) , MASS II [36] ( The Medicine, Angioplasty, or Surgery Study II ), RAVEL [37] ( randomised study with the sirolimus eluting Bx Velocity balloon expandable stent in the treatment of patients with de novo native coronary artery lesions ), RITA 2 [38] ( The second Randomised Intervention Treatment of Angina ), SIRIUS [11] ( Sirolimus-Eluting Stent in De-Novo Native Coronary Lesions), SoS [10] (the Stent or Surgery trial ), STRESS [39] ( Stent Restenosis Study), SYNTAX [40] (Synergy between PCI with Taxus and Cardiac Surgery ) and TAXUS IV [41] ( A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease ). The table S4 entitled “List of excluded and selected studies” presents the main reasons for exclusion.…”

“…For eight trials, the duration of follow-up was one year: BENESTENT II [29], MASS II [36], RAVEL [37], SIRIUS [11], SoS [10], STRESS [39], SYNTAX [40] and TAXUS IV [41]. For four trials, 3-year follow-up was available: ACME [26], COURAGE [14], EAST [30] and RITA 2 [38]. Two trials included both 1 and 3-year follow-up data: ARTS [27], [28] and ERACI [34], [35].…”

“…In four studies, the costs assessed were related to hospitalization and outpatient drugs: MASS II [36], RAVEL [37] TAXUS IV [41] and SoS [10]. In five studies, costs assessed were related to hospitalization, outpatient care (medical visit and/or cardiovascular testing) and outpatient drugs: ACME [26], COURAGE [14], RITA 2 [38], SIRIUS [11] and SYNTAX [40].…”

“…Eight trials are classified as “fully pooled with one-country costing”: ARTS [27], [28], BENESTENT II [29], COURAGE [14],, ENDEAVOR II [12], [31]–[33], RAVEL [37], RITA 2 [38], SoS [10] and SYNTAX [40]. The seven other studies are classified as “fully split with one-country costing”: ACME [26], EAST [30], ERACI [34], [35], MASS II [36], SIRIUS [11], STRESS [39] and TAXUS IV [41]. Our conclusions may therefore be limited by the methodological variability of the 16 trials we analyzed, although the results were fairly consistent regardless of the costing methods used.…”