Coronary stenting: costly or cost-effective?

In today's health care climate, decisions about new technologies need to reflect measures of cost as well as clinical benefit. By estimating the cost-effectiveness ratio for a new treatment compared to a current standard (e.g., stenting as compared to conventional PTCA), it is possible to decide whether the new treatment represents an efficient use of limited health care resources. In this analysis, stenting carried a $2500 greater in-hospital cost, which was partially defrayed by a $1900 savings in follow-up costs due to reductions in abrupt closure and restenosis. The net $600 increase in cumulative costs for stenting "bought" additional quality-adjusted life expectancy at a cost-effectiveness ratio of $33,700/QALY over conventional angioplasty, giving stenting a cost-effectiveness comparable to many other accepted medical therapies. Any future reduction in stent costs (e.g., by reducing length of stay or vascular complications) would improve this estimate of relative cost-effectiveness.