Medical economic considerations of coronary stenting.

Elective coronary stenting has been shown to reduce restenosis and improve clinical outcomes compared with balloon angioplasty. Despite the availability of numerous large-scale randomised and controlled clinical trials, few economic appraisals have been performed and reported. The majority of these were conducted in the US. Nonetheless, early studies have suggested that medical care costs remain higher with stenting, in part due to the prolonged length of stay and frequent vascular complications related to early periprocedural anticoagulation regimens. Recent long-term follow-up studies have demonstrated that initial costs are often recovered by avoiding complications. Some studies mainly built on modelling techniques even suggest that stenting is more cost-effective than balloon angioplasty, chiefly in single-vessel disease. If advances in newer stenting techniques can be confirmed by large randomised controlled studies, the additional procedural costs and health care resource consumption might be even more justified. This paper reviews and summarises the major economic evaluations comparing intracoronary stenting and angioplasty.