OPCAB surgery is cost-effective for elderly patients

Area of Science:

• Cardiovascular Surgery
• Health Economics
• Geriatric Medicine

Background:

• Coronary artery bypass surgery (CABG) is a common procedure for patients over 70.
• The choice between on-pump and off-pump CABG strategies involves considerations of efficacy, safety, and cost-effectiveness.
• Optimizing surgical strategy is crucial for improving patient outcomes and resource allocation in elderly populations.

Purpose of the Study:

• To determine the most cost-effective operative strategy for coronary artery bypass surgery in patients aged 70 years and older.
• To compare the direct and indirect costs associated with on-pump versus off-pump CABG.
• To evaluate the impact of both surgical approaches on patient quality of life.

Main Methods:

• A randomized controlled trial involving 900 patients over 70 undergoing CABG.
• Patients were randomized to either on-pump or off-pump CABG.
• Prospective data collection on direct/indirect costs and quality of life (EuroQol-5D) at pre-operative and 6-month post-operative time points.

Main Results:

• Both on-pump and off-pump CABG significantly improved quality of life (EuroQol-5D Summary Score) in patients over 70.
• Mean costs were lower for off-pump CABG (138,693 D.Kr) compared to on-pump CABG (148,940 D.Kr).
• Off-pump surgery demonstrated an 89% probability of being cost-effective at a threshold of 269,400 D.Kr/QALY.

Conclusions:

• Off-pump coronary artery bypass surgery is suggested to be a more cost-effective strategy for patients over 70 years of age.
• While quality of life improvements were similar between groups, cost savings favor the off-pump approach.
• Further long-term comparative studies are recommended to fully elucidate the benefits of off-pump CABG.