Review of recent US cost estimates of revascularization

OBJECTIVE: To review recent US cost estimates of revascularization and discuss their implications for third-party payers. STUDY DESIGN AND METHODS: A literature review was performed using MEDLINE. The review was limited to English-language articles published between January 2000 and September 2003. The most recently published articles that included US-derived clinical outcomes and costs of revascularization were selected for review. Cost estimates were abstracted and updated to 2003. RESULTS: Coronary revascularization procedures, including percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG), are commonly performed in the United States. These procedures are costly. Costs for PCI in single-vessel disease are lower than costs for PCI in multivessel disease. Although initial estimated costs are lower for multivessel PCI (with or without stenting) than CABG, longer-term costs and lifetime costs are similar. Drug-eluting stents have the potential to alter treatment and economics dramatically, although it is too early to draw definitive conclusions about their costs. It is imperative that cost comparisons be placed in the appropriate context. CONCLUSION: Revascularization procedures are costly, and short-term cost differences in procedures may not exist when considered long term. Importantly, recent cost data may be conservative given the rapid innovation in revascularization procedures and technology and the lag in publication of cost data reflecting these advances.