Resumen

BORRACCI, Raúl A.; RUBIO, Miguel  y  INSUA, Jorge T.. Medical Cost Study of Off-pump Coronary Artery Bypass Grafting. Rev. argent. cardiol. [online]. 2006, vol.74, n.5, pp.289-296. ISSN 1850-3748.

Background Some studies have reported that off-pump coronary artery bypass graft surgery is cost-saving when compared to conventional coronary surgery. Cost differences may be attributable to lower incidence of postoperative complications in off-pump group. However, it is still unknown the validity of this cost-effectiveness in Argentina, specially because of local higher costs with respect to operating materials and resources, and less costly bed occupancy. Study objective To perform a medical cost study of off-pump coronary artery bypass surgery, and to estimate its cost-effectiveness when compared with on-pump surgery. Research design and methods A retrospective cost analysis was carried over a series of 200 on- and off-pump coronary surgeries, performed during 2004 and 2005. Operating-room costs were determined directly, and length of stay cost was extrapolated from bed occupancy cost, exclusively for non complicated surgeries (base case). Postoperative complications influence on total cost was indirectly estimated through complication rates reported on clinical trials and its corresponding incremental cost, according to a previously communicated stochastic model. Finally a sensitivity analysis was done by means of a computer-aided dynamic simulation, taking into account two predictive parameters: coronary stabilizer reuse (OCTOPUS ®) and off-pump surgery use rate. Results Cost of non complicated coronary surgery oscillated between $9,340 and $12,540 (median = $10,750) for on-pump method, and between $10,100 and $15,300 (median = $12,100) for off-pump surgery. This higher cost was related to disposable coronary stabilizer price, comparatively more expensive than a membrane oxygenator used for extracorporeal circulation. Proportionally, operating-room total cost for off-pump surgery was between 15 and 39% more costly than conventional surgery. On the other hand, influence of postoperative complications on total cost showed values between $11,978 and $18,145 (median= $14,350) for off-pump surgery, and between $12,303 and $16,518 (median = $13,377) for on-pump method. Conclusions In this local study it was not possible to demonstrate a cost reduction with off-pump coronary artery surgery, with respect to on-pump procedure. Operating-room cost (disposable coronary stabilizer) seems to be the principal determinant for higher costs of off-pump in Argentina. Legal measures to allow reuse of "single use" medical devices, or an economical policy to reduce cost of surgical resources, could enhance costeffectiveness of off-pump surgery in our country.

Palabras clave : Thoracic surgery; Coronary disease; Extracorporeal circulation; Coronary Artery By Pass; Off Pump; Costs and cost analysis.