The expense incurred in treating patients with primary angioplasty is comprised of the cost of maintaining a 24-h availability for this procedure and the cost of the equipment and resources consumed during the actual procedure. Lieu et al. (106) determined that the additional cost of the procedure is only $1597 if the hospital already has 24-h coverage for acute coronary interventions. In contrast, if night call for the support personnel were a new expense, the cost would increase to at least $3206 for each procedure (assuming 200 patients/yr). A hospital envisioning building a new catheterization suite to provide primary angioplasty services would spend $3866-14,339 for the same volume, per case.
From the PAMI I study, Stone et al. (107) reported the cost analysis of 90% of the patients enrolled in the study. Total hospital charges (including professional fees) were similar in the PTCA and tPA groups. At a mean follow-up of 2.1 yr, there were no sig nificant differences in late events, such as death, reinfarction, revascularization, or recurrence of unstable angina, suggesting similar late resource consumption. Similar results were obtained from the Dutch primary angioplasty study (108). In the Mayo Clinic randomized trial of primary angioplasty and lytic therapy, the in-hospital costs were similar in the two groups, but the late costs were increased in the lytic group, because of increased need for angiography and revascularization (46).
In the PAMI II study, analysis of cost in a small subset of low-risk patients revealed marked savings in those allocated to early discharge, as compared to standard care following primary angioplasty.
The GUSTO IIb Investigators reported the cost analysis in a subset of patients enrolled in the primary angioplasty study (374 out of 1138) (109). The costs were remarkably similar for angioplasty and tPA patients both in-hospital and at 6 mo.
In contrast, the large observational series from the MITI registry (36) suggested that both the in-hospital cost and subsequent resource utilization over 3 yr were higher in the angioplasty, as compared to the lytic group.
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