[What aspects are inefficient concerning percutaneous coronary intervention in Japan?: International cost-effectiveness comparisons].

Objectives: To investigate the outcome-cost relationship of percutaneous coronary intervention (PCI) during 1 year in Japan and other countries. Foreign databases showing similar coronary events to those observed in Japan during the follow-up period were chosen.

Methods: The Japanese multicenter prospective observational cost database (JSIC) was compared to the Stent Restenosis Study (STRESS), a university hospital (DUKE), Arterial Revascularization Therapies Study (ARTS), and the Primary Angioplasty in Myocardial Infarction trial (PAMI). The presence of acute myocardial infarction (AMI), implantation of stents, and number of involved coronary vessels are known to affect the costs of the initial hospitalization and during the follow-up period. The JSIC database was subdivided according to those factors and the initial hospitalization expenses and follow-up costs was compared.

Results: All foreign databases showed similar outcomes for coronary events (deaths or repeat PCI or bypass surgery)compared to the JSIC during the 1 year follow-up period. The cumulative costs for the non-AMI group in the JSIC, STRESS, DUKE, and ARTS were 23.1, 11.3, 22.2, and 10.7 thousand dollars, respectively, and for the AMI group were 27.6 and 20.1 thousand dollars in the JSIC and PAMI, respectively. Balloon catheter costs of initial hospitalization expenses accounted for 50% in JSIC, 23% in STRESS, 31% in DUKE, and 16% in PAMI, but the mean numbers of balloons and stents used per patient were similar.

Conclusions: Costs for PCI were higher in Japan than in most other countries. The difference derived mainly from the higher costs of catheters, not from the longer hospital stay in Japan.