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Published on: March 27, 2018
Cost-effectiveness of bypass surgery versus stenting in patients with multivessel coronary artery disease
Cynthia A Yock1, Derek B Boothroyd, Douglas K Owens
1Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California 94305, USA.
Insights
Coronary artery bypass surgery is more cost-effective than angioplasty with stenting for multivessel disease. Bypass surgery offers better outcomes and lower costs compared to angioplasty interventions.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) management involves revascularization strategies.
- Surgical bypass and percutaneous coronary intervention (PCI) are primary treatment options.
- Cost-effectiveness analysis is crucial for guiding clinical decisions.
Purpose of the Study:
- To compare the cost-effectiveness of coronary artery bypass grafting (CABG) versus angioplasty with stenting.
- To evaluate long-term outcomes and costs from a societal perspective.
Main Methods:
- Utilized data from the Study of Economics and Quality of Life (a BARI substudy).
- Employed a Markov decision model to project lifetime costs and Quality-Adjusted Life-Years (QALYs).
- Accounted for technological advancements and improved procedural safety and efficacy.
Main Results:
- Surgical revascularization demonstrated lower costs and superior outcomes compared to catheter-based interventions, including stenting.
- Primary stenting strategy incurred an additional $189,000 per QALY gained versus selective stent use.
- Even after adjusting for restenosis, surgery remained the preferred strategy.
Conclusions:
- Coronary artery bypass surgery provides better outcomes and is more cost-effective than angioplasty for patients with multivessel coronary artery disease.
- Angioplasty with primary stenting is less cost-effective than selective stent use.
Purpose:
To compare the cost-effectiveness of surgical and angioplasty-based coronary artery revascularization techniques, in particular, angioplasty with primary stenting.
Methods:
We used data from the Study of Economics and Quality of Life, a substudy of the Bypass Angioplasty Revascularization Investigation (BARI), to measure the outcomes and costs of angioplasty and bypass surgery in patients with multivessel coronary artery disease who had not undergone prior coronary artery revascularization. Using a Markov decision model, we updated the outcomes and costs to reflect technology changes since the time of enrollment in BARI, and projected the lifetime costs and quality-adjusted life-years (QALYs) for the two procedures from the time of initial treatment through death. We accounted for the effects of improved procedural safety and efficiency, and prolonged therapeutic effects of both surgery and stenting. This study was conducted from a societal perspective.
Results:
Surgical revascularization was less costly and resulted in better outcomes than catheter-based intervention including stenting. It remained the preferred strategy after adjusting the stent outcomes to eliminate the costs and events associated with target lesion restenosis. Among angioplasty-based strategies, primary stent use cost an additional 189,000 US dollars per QALY gained compared with a strategy that reserved stent use for treatment of suboptimal balloon angioplasty results.
Conclusion:
Bypass surgery results in better outcomes than angioplasty in patients with multivessel disease, and at a lower cost.
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