Cost-Effectiveness of Coarctation Repair Strategies: Endovascular Stenting Versus Surgery

The cost-effectiveness of stent (ST) implantation for the repair of coarctation of the aorta (CoA) is not documented in the medical literature. Inflation-adjusted hospital costs for ST implantation and for surgical (SU) repair were obtained using the HBOC Cost Accounting System software and evaluated for all patients 5 years of age or older who underwent elective treatment of CoA between July 1997 and June 2001. The average age of the ST group (n = 10) was 12.2 ± 3.9 years compared to 9.5 ± 3.5 years for the SU group (n = 12) (p > 0.10). The ST group had one failure due to inability to cross the CoA (failure rate, 10%). Successful repair was accomplished in all other ST cases and in all SU cases, with no residual systolic gradients at 1-year follow-up. Hospital length of stay for the ST group was 0.8 ± 1.2 days compared to 3.5 ± 0.5 days for the SU group (p < 0.001). The mean inflation-adjusted cost for the ST group was $7,148 ± 2,984 versus $11,769 ± 3,702 for the SU group (p < 0.005). By intention to treat analysis, the cost of repair in the ST-first group was $8,325 ± 3,354 given the 10% failure rate (p < 0.04 vs the SU only group). Sensitivity analysis demonstrates that cost of repair is lower with the ST-first strategy compared to SU only until the failure rate of ST implantation exceeds 39%. Repair of CoA using an endovascular stent strategy is cost-effective compared to conventional surgical repair.