Cost of Veteran Coronary Artery Bypass Grafting: Veterans Health Administration Versus Community Care.

Cotton JL, Syed A, Abbitt D, Mecum A, Anigbogu C, Jones TS, Aftab M, Rove JY, Jones EL. Cost of Veteran Coronary Artery Bypass Grafting: Veterans Health Administration Versus Community Care. The Journal of surgical research. 2025 Oct 1; 315:145-150, DOI: 10.1016/j.jss.2025.09.001.

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Abstract:

INTRODUCTION: The community care program within the Veterans Health Administration (VHA) funds veteran care in the community. Cost of this program has increased with limited comparisons between VHA and community care hospitals. We seek to compare differences in cost of coronary artery bypass grafting (CABG) between VHA and community care hospitals. METHODS: We perform a retrospective cohort review of veterans undergoing CABG between October 1, 2018, and September 30, 2020, within VHA and community care hospitals within Veteran Integrated Service Network 19. Cost of index hospitalization was measured using VHA databases. RESULTS: Three hundred sixty-one veterans met final inclusion criteria at a total of 37 hospitals. One hundred ninety-five (54%) underwent surgery within the VHA and 166 (46%) underwent surgery in the community. CABG performed within the VHA were similar in cost to community (VHA median [interquartile range]: $122,213 [$80,829-$162,586] versus community: $112,923 [$74,797-$154,729]; P = 0.23), despite a longer postoperative length of stay. When controlling for other factors including hospital length of stay with a log gamma model, VHA performed CABG were less expensive than community (P = 0.007). There was no difference in index hospitalization metrics and 30-d outcomes. CONCLUSIONS: CABG within the VHA is lower cost than community care after controlling for other factors. Continuous evaluation of community care cost is necessary to ensure efficient use of funding and program sustainability.