Angioplasty Not Always Worth the Price

WEDNESDAY Nov. 12, 2008 -- The high cost of angioplasty may not justify the marginal benefit, a new study suggests.

Researchers reporting at the American Heart Association's (AHA) annual scientific sessions in New Orleans found that adding angioplasty to optimal medical therapy improved angina-related symptoms in some patients but "at a cost generally considered to be prohibitive as a routine initial management strategy."

"This is an important trial," said Dr. Sidney Smith, chairman of the AHA/American College of Cardiology task force on guidelines. "More and more as we develop guidelines and treatment strategies for patients, the cost is important, and in this particular trial, it appeared the use of stents and additional angina associated with that was expensive."

But this doesn't mean the procedure shouldn't be performed.

"Cost should not be a total roadblock," Smith said. "It should be an incentive to do things in a better way, by targeting the population or making the procedure or drug in a less expensive way. . . . Let's find a way to fix the cost."

Currently, cost analyses of procedures and medications tend to lag behind studies of their effectiveness and place in the practice of medicine.

Prior research suggests that interventional procedures to re-open coronary arteries after blockages, when used with up-to-date medical therapy, does not actually reduce the incidence of cardiovascular events any more than medication alone.

The original trial, known as COURAGE, compared adding angioplasty to best medical therapy and lifestyle interventions to medical therapy alone in reducing the risk of dying or having a heart attack. It found little difference between the two.

According to the AHA, angioplasty involves inserting a thin tube from a groin artery to the blocked artery in the heart. Doctors then inflate a small balloon at the tip of the tube to widen the vessel, insert a stent and restore blood flow.

This secondary analysis involved 2,287 patients who were followed for a median of 4.6 years. Researchers compared the cost of treating angina in Canada, the U.S. non-VA health system and the U.S. VA health system.

Quality of life results were similar among groups, although physical limitation results did vary. The net benefit here ranged from less than 1 percent in U.S. non-VA hospitals to 18 percent in Canadian facilities.

When measured by the frequency of chest pain, researchers calculated the absolute net benefit to be 6.85 percent, with an average added cost for the PCI of $10,107 per patient.

The added cost of PCI ranged from a low of $5,906 per patient in Canada to a high of $15,896 in U.S. VA hospitals.

The overall cost per patient related to angina frequency (as assessed by a patient questionnaire) ranged from a low of $55,700 in Canada (the average in Canada was $118,740) to a high of more than $1 million at U.S. non-VA facilities. The analysis was done in 2004 U.S. dollars.

Posted: November 2008


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