Clinical correlates of the initial and long-term cost of coronary bypass surgery and coronary angioplasty

• Published in: The American heart journal 1999-08, Vol.138 (2), p.376-383
• Main Authors: Hlatky, Mark A., Boothroyd, Derek B., Brooks, Maria Mori, Winston, Carla, Rosen, Allan, Rogers, William J., Reeder, Guy S., Smith, Hugh C., Ryan, Thomas J., Pitt, Bertram, Whitlow, Patrick L., Wiens, Robert D., Mark, Daniel B.
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - economics; Biological and medical sciences; Cardiology. Vascular system; Coronary Artery Bypass - economics; Coronary Disease - economics; Coronary Disease - surgery; Coronary Disease - therapy; Coronary heart disease; Episode of Care; Female; Health Care Costs - statistics & numerical data; Health Services Research - economics; Heart; Humans; Male; Medical sciences; Medicare; Middle Aged; United States
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(99)70128-6

Background Medical costs vary substantially among patients. Understanding the baseline factors that predict subsequent cost may allow better selection of therapy for individual patients. Understanding the postprocedure events that increase cost should help to improve efficiency and effectiveness of coronary revascularization. Methods Data on 4-year costs were collected from patients randomly assigned to coronary angioplasty or bypass surgery as part of the BARI (Bypass Angioplasty Revascularization Investigation) trial. Regression models first examined factors known at the time of randomization that prospectively predicted initial procedure cost and long-term cost. Subsequent models tested the value of postrandomization events as explanatory variables for cost. Results The independent baseline predictors of higher initial percutaneous transluminal coronary angioplasty cost included 3-vessel disease (+12%) and acute presentations (+22%), whereas the independent predictors of higher initial coronary artery bypass grafting cost included the number of comorbid conditions (+5% per condition) and female sex (+7%). The independent baseline predictors of 4-year cost included heart failure (+26%), diabetes (+22%), comorbidity (+10%), and angioplasty assignment in patients with 2-vessel disease (–15%). Postrandomization models showed higher initial and long-term costs were strongly correlated with the number of repeat revascularization procedures (+30% to +128%) and the occurrence of clinical complications (+8% to +131%). Conclusions Two-vessel disease identifies patients likely to have lower costs after angioplasty, whereas heart failure, comorbid conditions, and diabetes identify patients likely to accrue higher costs after either angioplasty or bypass surgery. Long-term costs can be potentially reduced by interventions that decrease procedural complications or reduce the need for repeat revascularization. (Am Heart J 1999;138:376-83.)