Objective: Although the benefits of coronary stenting have been demonstrated in several large clinical trials, controversy remains as to whether stenting results in long-term cost savings compared to percutaneous transluminal coronary angioplasty (PTCA). The objective of this study was to evaluate the resource use and cost (Medicare payment) of PTCA versus bare stent in actual practice over a 2-year period.
Methods: The data for this study came from the 1996 through 1998 Standard Analytic Files that contain 5% of Medicare claims. The rates of repeat revascularization procedures and hospitalizations were reported at 1 and 2 years. Costs associated with inpatient admission, outpatient procedures, physician services, skilled nursing facility admissions, and home health-care services were included to perform a comprehensive assessment. Regression analysis was performed to test for cost differences controlling for case-mix variation between the patient groups.
Results: The selection process yielded 3782 PTCA patients and 2690 stent patients for analysis. The rate of revascularization was 26.7% for the PTCA group and 22.2% for the stent group at 2 years. The mean total cost for the initial procedure was 13,724 dollars for PTCA and 15,021 dollars for stenting. At 2 years, the total cumulative cost was 32,654 dollars for the PTCA group and 32,102 dollars for the stent group, a difference that was not statistically significant.
Conclusion: Although the difference in the rate of repeat revascularization procedures between PTCA and stenting is not as large as those reported in clinical trials, bare stents are cost-neutral when compared to PTCA for the Medicare population.