Although there are no differences in clinical outcome, the in-hospital cost of coronary bypass surgery in the U.S. is 82.5 percent higher in the U.S. than in Canada, according to a study in the July 11 issue of Archives of Internal Medicine.

Cardiovascular disease is a leading cause of illness and death in the U.S. and Canada, with an estimated direct cost in the U.S. of $209.3 billion in 2003, including $94.1 billion in in-hospital costs alone. In 2000, more than 500,000 bypass procedures were performed in the U.S.

Mark J. Eisenberg, M.D., M.P.H., of Jewish General Hospital, Montreal, and colleagues compared the outcomes and costs of treatment of 12,017 consecutive patients (4,698 U.S. and 7,319 Canadian patients) undergoing CABG at five U.S. 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 report.

"After controlling for demographic and clinical differences, length of stay in Canada was 16.8 percent longer than in the United States; there was no difference in in-hospital mortality; and the cost in the United States was 82.5 percent higher than in Canada."

"Coronary artery bypass graft (CABG) surgery requires substantial resources in Canada and the United States," the authors conclude. "However, patients undergoing CABG at U.S. 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 U.S. hospitals. This cost differential primarily reflects higher resource prices for products and labor and higher overhead costs in the United States resulting from a nonsocialized medical system. However, U.S. hospitals also appear to streamline services better to reduce LOS, a strategy Canadian hospitals might emulate to further reduce treatment costs."