US outstrips Canada in coronary artery bypass graft surgery costs

According to a study, supported by an unrestricted research grant from Pfizer, Inc., and  appearing in a recent issue of Archives of Internal Medicine, the in-hospital cost of coronary artery bypass graft surgery (CABG) in the US is 82.5% higher than in Canada -- although there are no differences in clinical outcome.

Cardiovascular disease (CD) is a leading cause of illness and death in the US and Canada. The article’s background revealed that in 2000, more than 500,000 CABGs were performed in America. In 2003, the estimated direct cost of CD in the US was $209.3 billion, including $94.1 billion in in-hospital costs alone.

Mark J. Eisenberg, MD, MPH, of Jewish General Hospital, Montreal, and colleagues compared the outcomes and costs of treatment of 12,017 consecutive patients (4,698 US and 7,319 Canadian patients) undergoing CABG at five US and four Canadian hospitals.

“In-hospital costs of treatment were substantially higher in the United States than in Canada [an average cost of $20,673 vs. $10,373],” the authors reported. “After controlling for demographic and clinical differences, length of stay in Canada was 16.8%  longer than in the United States; there was no difference in in-hospital mortality [death]; and the cost in the United States was 82.5% higher than in Canada.”

The authors concluded: “Coronary artery bypass graft surgery requires substantial resources in Canada and the United States. However, patients undergoing CABG at US hospitals incur approximately twice as much cost compared with those at Canadian hospitals, with little difference in clinical outcome and despite shorter average LOS [length of stay]. The difference in total in-hospital costs is almost equally attributable to differences in direct and overhead costs between the Canadian and US hospitals. This cost differential primarily reflects higher resource prices for products and labor and higher overhead costs in the United States resulting from a non-socialized medical system.”

SOURCE: Arch Intern Med. July 11, 2005; 165:1506-1513.