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Comparing cost aspects of coronary artery bypass graft surgery with coronary artery stenting
Ö Birim1, A J J C Bogers, A P Kappetein
1Department of Cardio-Thoracic Surgery, Erasmus MC Rotterdam, Rotterdam, The Netherlands. o.birim@erasmusmc.nl
Insights
Coronary artery bypass graft surgery (CABG) is more cost-effective than percutaneous coronary intervention (PCI) for coronary artery disease, despite higher initial costs. Long-term data are needed, but CABG may offer superior benefits and net cost savings over time.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) management involves surgical (CABG) and percutaneous (PCI) revascularization.
- CABG improves quality of life but has higher initial costs.
- PCI with stenting has limitations including restenosis and thrombosis.
Purpose of the Study:
- To review the cost-effectiveness of CABG versus PCI for CAD.
- To compare the long-term economic and clinical outcomes of these interventions.
Main Methods:
- Review of randomized trials comparing CABG and PCI.
- Analysis of cost-effectiveness data, considering initial costs, subsequent procedures, and long-term benefits.
- Evaluation of evidence limitations and the need for long-term outcome data.
Main Results:
- PCI incurs high costs due to repeat revascularization and lacks mortality/survival benefits over CABG.
- Despite lower initial costs, PCI is not cost-effective compared to CABG in the short term.
- Long-term benefits may favor CABG, with potential net cost savings, though data are limited.
Conclusions:
- Current evidence suggests CABG may be more cost-effective than PCI for CAD in the long term.
- Further long-term data, such as from the SYNTAX trial, are crucial for definitive conclusions.
- The choice of intervention requires careful consideration of short-term versus long-term cost-effectiveness and patient outcomes.
Abstract:
Randomized trials have compared revascularization of coronary artery disease by coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). CABG is an expensive treatment. However, it manages to improve quality of life, restore general well being, and alleviate symptoms of patients. Coronary stents have improved the safety and durability of PCI. Nonetheless, stenting remains limited by a relatively high in-stent restenosis and thrombosis rate. The costs and cost-effectiveness for these different treatment modalities are relevant issues because cardiovascular disease and its management are prime targets for cost reduction initiatives. There is a debate as to which is the optimal treatment strategy as well as to the cost-effectiveness comparing CABG and PCI. This review provides an overview of cost-effectiveness of CABG compared with PCI. PCI has high costs due to the need for subsequent revascularization procedures, with absence of mortality and survival benefit compared with CABG. Despite the relative lower initial costs of PCI in the first year, PCI is not a cost-effective intervention in comparison with CABG. However, the studies undertaken to date have predominantly been short term and provide a very limited evidence base by which to assess the cost-effectiveness of modern clinical practice. It seems that in longer term, the benefits of CABG may exceed those of stenting and the difference in net cost may be in favour of CABG as the risk of repeat revascularization still increases with PCI regardless of the use of DES. However, to date no long-term data are available in cost-effectiveness between CABG and PCI. The 5-year outcome of the ongoing SYNTAX trial is essential and might therefore provide new insights into the comparison of cost-effectiveness between CABG and DES PCI.
