Analysis of costs associated with CABG and PTCA

Background. Factors related both to the patient and to the healthcare provider affect the costs of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG). The costs of both PTCA and CABG are most highly dependent on the occurrence of complications in the postprocedure period. Costs are lower in centers that have adequate procedure volumes, due partly to economics of scale and partly to improved outcomes. Methods. The relative costs of PTCA and CABG in patients suitable for either procedure is being investigated in several ongoing randomized clinical trials. The cost-effectiveness of coronary revascularization relative to medical therapy has also been investigated. The cost-effectiveness of PTCA relative to medical therapy has not been evaluated. Results. The initial cost of PTCA is roughly half that of CABG, but costs are similar after 2- or 3-year follow-up because of the need for repeat revascularization procedures in patients initially treated with PTCA. The data on cost-effectiveness of coronary revascularization relative to medical therapy have shown that CABG is particularly cost-effective in patients for whom survival is improved or in whom symptoms of severe angina are relieved. Conclusions. Percutaneous transluminal coronary angioplasty and CABG are costly but effective therapies. Clearly PTCA costs less initially hut the follow-up costs are much higher. The cost-effectiveness of coronary revascularization can be improved by maintaining adequate procedural volumes, reducing procedural complications, and selecting patients properly.