Assuntos
Alocação de Custos/tendências , Economia Hospitalar , Administração Financeira de Hospitais/tendências , Medicare/economia , Competição Econômica , Eficiência , Pesquisa sobre Serviços de Saúde , Humanos , Patient Protection and Affordable Care Act , Cuidados de Saúde não Remunerados , Estados UnidosRESUMO
BackgroundCoronary stenting improves outcomes compared with balloon angioplasty, but it is costly and may haveother disadvantages. Limiting stent use to patients with a suboptimal result after angioplasty (provisional angioplasty) may be as effective and less expensive.Methods and ResultsTo analyze the cost-effectiveness of provisional angioplasty, patients scheduled for single-vessel angioplasty were first randomized to receive primary stenting (97 patients) or balloon angioplasty guided by Doppler flow velocity and angiography (523 patients). Patients in the latter group were further randomized after optimization to either additional stenting or termination of the procedure to further investigate what is optimal. An optimal result wasdefined as a flow reserve 2.5 and a diameter tenosis 36%. Bailout stenting was needed in 129 patients (25%) who were randomized to balloon angioplasty, and an optimal result was obtained in 184 of the 523 patients (35%). There was no significant difference in event-free survival at 1 year between primary stenting (86.6%) and provisional angioplasty (85.6%). Costs after 1 year were significantly higher for provisional angioplasty (EUR 6573 versus EUR 5885; (P50.014). Results after the second randomization showed that stenting was also more effective after optimal balloon angioplasty (1-year event free survival, 93.5% versus 84.1%; P50.066). ConclusionsAfter 1 year of follow-up, provisional angioplasty was more expensive and without clinical benefit. The beneficial value of stenting is not limited to patients with a suboptimal result after balloon angioplasty.
Assuntos
Alocação de Custos/tendências , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/tendências , Análise Custo-Benefício/tendências , Stents/normas , Stents/tendênciasRESUMO
Contiene: Actividad económica y violencia; La dotación y la distribución de recursos; la perticipación en la producción; Las condiciones de intercambio y las posibilidades de bienestar; Las consecuencias del despojo, la exclusión y la discriminación: la pobreza; Conclusiones