OBJECTIVE: To estimate the economic value of the 4F catheter relative to the 6F in diagnostic coronary angiography.
METHODS: A decision tree model was developed, based on German practice patterns and costs. Expected total costs of diagnostic coronary angiography using 4F and 6F catheters in both the ambulatory and inpatient settings were calculated and compared, together with measures of procedure success. Costs include the costs of catheters, contrast media, time in clinic, professional services, and costs to treat complications. Measures of procedure success, as observed in trials of 4F versus 6F, include fluoroscopy, procedure, compression, and immobilization times; complication rates; and catheter exchange rates. Complication rates are those observed in two large German observational studies.
RESULTS: In the base-case scenario, the 4F catheter saves an average of 22 DM per procedure, despite a higher list price. These savings derive primarily from reduced need for contrast media. The 4F is associated with fewer complications; however, because of the low overall complication rate, the associated savings are minor. Given a lower likelihood of bleeding complications, the 4F may enable more procedures to be performed in the ambulatory setting. Assuming a modest increase in the proportion of ambulatory procedures results in an additional savings of 10 DM per procedure.
CONCLUSION: Compared to the 6F catheter, the 4F is estimated to save an average of 22 DM per diagnostic coronary angiography because of a reduced need for contrast media and a lower complication rate. If the 4F catheter enables more procedures to be performed on an outpatient basis, the potential cost savings increase.
