[Coronary angioplasty: use and cost].

OBJECTIVES

The goal of the study was to examine the utilization of cardiac catheterization laboratory resources in surgical procedures in order to determine the cost impact of introducing new devices such as stents and atherectomy.

METHODS

Detailed resource utilization and costs of each cardiac catheterization laboratory procedure performed in 1995 were determined. Costs were analyzed for single-vessel and multivessel coronary angioplasty, also taking into account the additional costs for coronary stent placement or for the use of directional atherectomy.

RESULTS

The mean cost of a surgical procedure was ITL 8,280,010, while the mean cost for conventional coronary angioplasty was ITL 4,352,427 (ITL 4,293,108 for single-vessel PTCA; ITL 5,072,841 for multivessel PTCA). The mean cost for a procedure with stent implantation was ITL 10,084,563. As compared to conventional angioplasty, coronary stenting had a 131.6% higher catheterization laboratory cost and an additional cath-lab resource utilization in terms of contrast medium (257 +/- 136 ml vs 216 +/- 109 ml, p = 0.018) and balloon catheter (1.97 +/- 1.27 vs 1.54 +/- 0.78, p = 0.0009). The cost for a directional atherectomy followed by stent placement was ITL 18827545, which is 332.5% higher than the cost of a conventional angioplasty.

CONCLUSIONS

Coronary stents and directional atherectomy have a significant economic impact on catheterization laboratory resource utilization and costs. This aspect should be taken into consideration in analyzing the short- and long-term results of these techniques.