Hospitalization Costs of Primary Stenting Versus Thrombolysis in Acute Myocardial Infarction

Abstract

Background— We previously showed that primary stenting was more effective than accelerated tPA in reducing the 6-month composite of death, reinfarction, stroke, or repeat revascularization for ischemia. This study looks at the hospitalization costs of primary stenting compared with accelerated tPA. Methods and Results— Initial and 6-month hospitalization costs were computed for all patients randomly assigned to primary stenting (n=62) or accelerated tPA (n=61) in the Stenting versus Thrombolysis in Acute myocardial infarction Trial (STAT). Costs and resource usage were collected in detail for each patient. Physician fees were obtained directly from billings to the Ontario Health Insurance Plan. The length of initial hospitalization was 6.7±11.3 days in the stent group and 8.7±6.7 days in the tPA group ( P <0.001). Total hospitalization days at 6 months were 8.3±13 days in the stent group and 12.1±14.0 days in the tPA group ( P =0.001). Hospitalization costs were less in the stent group for the initial hospitalization, $6354±6382 versus $7893±4429 ( P =0.001), and at 6 months, $7100±7111 versus $9559±6933 ( P =0.001). Conclusions— In centers in which facilities and experienced interventionists are available, primary stenting is less costly and more effective than thrombolysis.