Outcomes and Cost of Coronary Artery Bypass Graft Surgery in the United States and Canada

Eisenberg, Mark J.; Filion, Kristian B.; Azoulay, Arik; Brox, Anya C.; Haider, Seema; Pilote, Louise

doi:10.1001/archinte.165.13.1506

Cited by 65 publications

(33 citation statements)

References 18 publications

(21 reference statements)

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“…After controlling for demographic and clinical differences, length of stay in Canada was 16.8% longer than in the United States; there was no difference in in-hospital mortality; and the cost in the United States was 82.5% higher than in Canada. 299 …”

Section: %mentioning

confidence: 99%

Heart Disease and Stroke Statistics—2006 Update

Thom¹,

Haase²,

Rosamond³

et al. 2006

Circulation

2,158

513

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Section: %mentioning

confidence: 99%

Heart Disease and Stroke Statistics—2006 Update

Thom¹,

Haase²,

Rosamond³

et al. 2006

Circulation

2,158

513

View full text Add to dashboard Cite

“…42 Cost-effectiveness thresholds in Canada are ϽCan $50 000 per QALY gained and ϽCan $12 551 per repeat revascularization avoided. 26 Bowen et al 22 performed a cost-effectiveness analysis of DES for the Ontario Ministry of Health and Long-Term Care.…”

Section: Eisenberg Drug-eluting Stentsmentioning

confidence: 99%

Are Drug-Eluting Stents Cost-Effective?

Ryan

Cohen

2006

Circulation

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Since their commercial introduction in 2003, drugeluting stents (DES) have rapidly altered the management of coronary artery disease. Before their development, the percutaneous management of coronary artery disease was performed predominantly by implantation of bare metal stents (BMS) made of either surgical stainless steel or metal alloys. Although such stents represented a considerable advance over balloon angioplasty alone, they remained limited by restenosis resulting from neointimal proliferation. As a result, Ϸ15% to 20% of patients treated with BMS required Ն1 repeat revascularization procedure within the 6 to 12 months after stent implantation. 1 Despite numerous attempts at systemic pharmacotherapy, device modification, and even use of ionizing radiation, the rate of restenosis after BMS implantation remained largely unaffected. Response by Eisenberg p 1744Over the past 5 years, effective DES have become the first device to substantially reduce the incidence of restenosis after stent implantation. By delivering high concentrations of either antiproliferative or immunomodulatory compounds directly to the site of arterial injury and by controlling this delivery through polymer-based drug release, both sirolimus-and paclitaxel-eluting stents have safely and effectively inhibited the proliferative process that results in in-stent restenosis. In pivotal clinical trials, both sirolimus-and paclitaxel-eluting stents have reduced rates of angiographic restenosis by 70% to 90% compared with conventional BMS designs, with parallel reductions in the need for clinically driven target vessel revascularization (TVR). 2-4 As a result, in April 2003, DES were approved for use in clinical practice in the United States. Within 9 months of their introduction, DES made up 35% of all stent implantations in the United States, 5 and their use has increased rapidly since that time. At our own institution, DES comprised Ͼ85% of all stents implanted during the past year, and national estimates are that Ͼ90% of all percutaneous coronary intervention (PCI) procedures currently performed in the United States involve Ն1 DES.Given current procedural volumes (Ͼ1 million PCI procedures were performed in the United States in 2004) 6 and costs (DES are generally 3 to 4 times more expensive than BMS), the rapid growth of this technology has raised important concerns about cost from both a hospital and a societal perspective. 7,8 Because annual increases in US healthcare expenditures consistently outpace inflation, 9 there is increasing interest in formally evaluating the economic impact of new technologies both before and immediately after their introduction. The aim of the present report is to summarize the economic consequences of current DES use and to explore the possible future impact of DES on US healthcare expenses.

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“…Researchers have investigated the factors influencing the high costs of CABG and have concluded that length of stays, race, age, prescription are the major factors. [23][24][25] Given the high cost of CABG surgery, reducing the number of procedures and/or lowering the unit costs might be costeffective strategies in containing the overall costs associated with IHD. Our finding in the logit model that men were more likely than women and patients aged 40-54 more likely than those either 18-39 or 55-64 to have IHD as the primary diagnosis rather than a secondary diagnosis is of great interest and adds to the literature on IHD among American adults.…”

Section: Discussionmentioning

confidence: 99%