A Cost-benefit Analysis of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting using Reimbursement Data of Japan: A Single-center Pilot Study

Background: Although there have been studies comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), few comparative cost-benefit analyses using reimbursement data have been performed, especially in Japan. Data from the Diagnosis Procedure Combination/Per-Diem Payment System (DPC/PDPS), a reimbursement system in Japan, may be useful in performing a cost-benefit analysis. Methods and Results: Between July 2008 and March 2016, a total of 48,177 patients were admitted to Saga University Hospital. Using DPC/PDPS data, we identified 638 patients without a history of myocardial infarction who underwent PCI (Group PCI, n=462) or isolated CABG (Group CABG, n=176). There were no marked differences in the mortality rate, but the incidence of myocardial infarction was higher in Group PCI. A multivariate logistic regression analysis showed that performing PCI was a significant risk factor for myocardial infarction. The number of admissions was smaller in Group CABG, but the medical cost was higher and the total hospital stay was longer than in Group PCI. However, after three or more PCIs, the difference in medical cost disappeared between PCI and CABG. Conclusions: In our single-center experience, we were able to show that, while there was no marked difference in the survival rate, the incidence of myocardial infarction was higher with PCI than with CABG. PCI required multiple admissions but was less costly than CABG. The feasibility of using the DPC/PDPS data for cost-benefit analysis of procedures like PCI and CABG should be confirmed in a multi-center study.