Cost-effectiveness of coronary artery bypass grafts versus percutaneous coronary intervention for revascularization...

Area of Science:

• Cardiology
• Health Economics

Background:

• High-risk patients with medically refractory myocardial ischemia are often excluded from clinical trials.
• Previous trials have not adequately assessed revascularization strategies for this population.

Purpose of the Study:

• To evaluate the cost-effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in high-risk patients with medically refractory myocardial ischemia.
• To compare survival rates and total costs associated with PCI and CABG over a 5-year period.

Main Methods:

• A randomized trial involving 454 high-risk patients across 16 Department of Veterans Affairs medical centers.
• Economic analysis from a third-party payer's perspective, assessing total costs and survival at 3 and 5 years.
• Bootstrapping methods were used to estimate confidence intervals and assess the precision of cost-effectiveness estimates.

Main Results:

• After 3 years, PCI was associated with lower average total costs ($63,896) compared to CABG ($84,364), with similar survival rates (0.82 for PCI vs. 0.79 for CABG).
• At 5 years, PCI remained less costly ($81,790) than CABG ($100,522), with comparable survival rates (0.75 for PCI vs. 0.70 for CABG).
• PCI was found to be less costly and more effective in over 89% of bootstrap replications at both 3 and 5 years.

Conclusions:

• Percutaneous coronary intervention (PCI) is a less costly and at least as effective strategy for urgent revascularization in high-risk patients with medically refractory conditions over a 5-year period.
• These findings support the use of PCI for selected high-risk patient populations previously underserved by clinical research.