Cost-effectiveness of percutaneous coronary intervention with drug eluting stents versus bypass surgery for patients...

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Interventional Cardiology

Background:

• Previous studies indicated coronary artery bypass grafting (CABG) cost-effectiveness over percutaneous coronary intervention (PCI) in the bare metal stent era.
• The cost-effectiveness of CABG versus drug-eluting stent PCI (DES-PCI) in the current era remains undetermined, particularly for complex cases.

Purpose of the Study:

• To evaluate the lifetime cost-effectiveness of CABG compared to DES-PCI for patients with diabetes mellitus and multivessel coronary artery disease.

Main Methods:

• A randomized trial involving 1900 patients with diabetes and multivessel coronary artery disease comparing DES-PCI and CABG.
• Cost assessment from a U.S. healthcare system perspective and health state utilities using the EuroQOL 5D-3L questionnaire.
• Patient-level microsimulation model to estimate lifetime cost-effectiveness based on in-trial results.

Main Results:

• Initial hospitalization costs were higher for CABG, but 5-year cumulative costs were $3641 higher per patient with CABG.
• DES-PCI had higher follow-up costs due to repeat revascularization and medication expenses.
• CABG demonstrated modest survival gains during the trial, with projected lifetime economic attractiveness.

Conclusions:

• Despite higher initial costs, CABG is a highly cost-effective revascularization strategy compared to DES-PCI for patients with diabetes and multivessel coronary artery disease.
• CABG is projected to provide substantial gains in life expectancy and quality-adjusted life expectancy.
• Incremental cost-effectiveness ratios for CABG were favorable, suggesting economic viability.