Coronary revascularization safer, cheaper in England vs. New York

Patients are significantly more likely to die within one year of coronary artery bypass graft (CABG) surgery or PCI in New York state than in England where the procedures are roughly four times cheaper, according to a study in Open Heart.

The U.S. spends more per capita on healthcare than any other developed nation but lags behind others in performance measures, wrote lead researcher Francisco Leyva, MD, with Aston Medical Research Institute in the United Kingdom, and colleagues. According to the authors, the cost of cardiovascular disease in the U.S. has been projected to grow from $656 billion in 2015 to $1.21 trillion in 2030.

“Such a high cost burden begs a comparison of costs and outcomes of cardiovascular procedures in the USA and England,” the researchers wrote.

Leyva et al. studied 142,969 patients undergoing a first CABG and 431,416 undergoing a first PCI.

Total mortality was lower in England across the board. For CABG, mortality was 0.72 percent lower at 30 days and 3.68 percent lower at one year. For PCI, mortality was 0.35 percent lower at 30 days and 3.55 percent lower at one year.

However, after multivariable adjustment, significant differences only existed between England and New York at the one-year mark. England’s death rates were 26 percent lower for CABG and 34 percent lower for PCI at that point.

In addition, the researchers found cost was 3.8 times higher in New York for CABG and 3.6 times higher for PCI. The costs were for the procedures alone—not follow-up care or reintervention—and factored in exchange rates and the purchasing power of the countries’ currencies.

“Unfortunately, administrative databases lack granularity and further statistical analysis of our data is unlikely to shed light on the factors that contribute to observed differences in crude outcomes,” Leyva and coauthors wrote. “It might be considered, however, that the observed differences are clinically acceptable, particularly in view that we are dealing with different healthcare systems in different countries.

“It is also possible that patients with greater comorbidity are being treated in NYS. On the other hand, that comorbidities tend to be under-reported in England. This could explain differences in outcomes.”

The authors said the cost differences could be explained by the U.S.’s penchant to pay more for healthcare in general. A 2006 analysis showed the cost of healthcare per capita, adjusted for cost of living, was $6,714 in the U.S. versus $2,880 in other industrialized nations.

Leyva and colleagues noted they were unable to assess patients’ disease severity and socioeconomic status, both of which could have influenced outcomes. In addition, the data from New York may not be generalizable to the rest of the U.S.