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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Cost effectiveness of clinically appropriate decisions on alternative treatments for angina pectoris: prospective
S C Griffin1, J A Barber, A Manca
1Centre for Health Economics, University of York, York, USA.
Insights
Coronary artery bypass grafting is cost-effective for appropriate patients, unlike percutaneous coronary intervention. This study on revascularisation found CABG offers better value than PCI or medical management for selected patients.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Revascularisation procedures are common for coronary artery disease.
- Assessing the cost-effectiveness of different revascularisation strategies is crucial for healthcare resource allocation.
- Clinical appropriateness does not always guarantee economic value.
Purpose of the Study:
- To evaluate the cost-effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) versus medical management.
- To determine if clinically appropriate revascularisation strategies are also economically viable.
- To compare these interventions in patients selected for revascularisation.
Main Methods:
- Prospective observational study conducted across three London tertiary care centres.
- Included consecutive patients deemed appropriate for CABG only, PCI only, or both.
- Cost per quality-adjusted life year (QALY) gained was calculated over six years from an NHS perspective, discounted at 3.5%.
Main Results:
- CABG demonstrated cost-effectiveness, costing £22,000/QALY compared to PCI for CABG-appropriate patients and £19,000/QALY compared to medical management for patients appropriate for both.
- PCI was not cost-effective at a £30,000/QALY threshold in any appropriateness group.
- For patients appropriate for PCI only, PCI cost £47,000/QALY compared to medical management, which was more likely to be cost-effective (54% probability).
Conclusions:
- Coronary artery bypass grafting appears to be a cost-effective option for patients deemed clinically appropriate for revascularisation.
- Percutaneous coronary intervention did not demonstrate cost-effectiveness in this patient cohort.
- Observational data suggest the clinical benefits of PCI may not justify its cost in certain patient groups.
Objective:
To assess whether revascularisation that is considered to be clinically appropriate is also cost effective.
Design:
Prospective observational study comparing cost effectiveness of coronary artery bypass grafting, percutaneous coronary intervention, or medical management within groups of patients rated as appropriate for revascularisation.
Setting:
Three tertiary care centres in London.
Participants:
Consecutive, unselected patients rated as clinically appropriate (using a nine member Delphi panel) to receive coronary artery bypass grafting only (n=815); percutaneous coronary intervention only (n=385); or both revascularisation procedures (n=520).
Main Outcome Measure:
Cost per quality adjusted life year gained over six year follow-up, calculated with a National Health Service cost perspective and discounted at 3.5%/year.
Results:
Coronary artery bypass grafting cost 22,000 pounds sterling (33,000 euros; $43,000) per quality adjusted life year gained compared with percutaneous coronary intervention among patients appropriate for coronary artery bypass grafting only (59% probability of being cost effective at a cost effectiveness threshold of 30,000 pounds sterling per quality adjusted life year) and 19,000 pounds sterling per quality adjusted life year gained compared with medical management among those appropriate for both types of revascularisation (probability of being cost effective 63%). In none of the three appropriateness groups was percutaneous coronary intervention cost effective at a threshold of 30,000 pounds sterling per quality adjusted life year. Among patients rated appropriate for percutaneous coronary intervention only, the cost per quality adjusted life year gained for percutaneous coronary intervention compared with medical management was 47,000, pounds sterling exceeding usual cost effectiveness thresholds; in these patients, medical management was most likely to be cost effective (probability 54%).
Conclusions:
Among patients judged clinically appropriate for coronary revascularisation, coronary artery bypass grafting seemed cost effective but percutaneous coronary intervention did not. Cost effectiveness analysis based on observational data suggests that the clinical benefit of percutaneous coronary intervention may not be sufficient to justify its cost.
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