Coronary bypass surgery versus percutaneous coronary intervention: cost-effectiveness in Iran: a study in patients
Mehdi Javanbakht1, Razieh Yazdani Bakhsh2, Atefeh Mashayekhi3
1Health Economics Research Unit,Institute of Applied Health Sciences,University of Aberdeen;Health Management and Economics Research Center,School of Health Management and Information Sciences,Iran University of Medical Sciencesm.javanbakht@abdn.ac.uk.
Insights
Coronary artery bypass graft (CABG) is more cost-effective than percutaneous coronary intervention (PCI) for multivessel coronary artery disease in the long term, despite higher initial costs and lower quality of life. This finding is from the perspective of Iran's healthcare system.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) management involves revascularization strategies like CABG and PCI.
- Evaluating the long-term cost-effectiveness of these interventions is crucial for healthcare policy.
Purpose of the Study:
- To assess the cost-effectiveness of CABG versus PCI with stenting for CAD patients from Iran's societal perspective.
- To compare lifetime costs, life-years (LYs), and quality-adjusted life-years (QALYs) of both procedures.
Main Methods:
- Retrospective study of 109 patients undergoing PCI (n=75) or CABG (n=34).
- Development of a Markov model to estimate costs and HRQoL.
- Probabilistic sensitivity analysis was employed to ensure model robustness.
Main Results:
- CABG demonstrated superior long-term outcomes, with higher QALYs (8.74 vs. 8.33) and lower lifetime costs (USD 14,037 vs. USD 18,798) compared to PCI.
- Incremental cost-effectiveness ratio (ICER) indicated CABG as a dominant strategy at 10-year and lifetime horizons.
- Initial costs for CABG were higher, but long-term health-related quality of life (HRQoL) was lower.
Conclusions:
- CABG is a cost-effective revascularization strategy compared to PCI for patients with multivessel coronary artery disease in the long term.
- Despite initial higher costs and lower HRQoL, CABG offers better long-term value.
- Findings support CABG as a preferred strategy for specific patient populations in Iran.
Objectives:
The aim of this study was to evaluate cost effectiveness of coronary artery bypass graft (CABG) versus percutaneous coronary intervention (PCI) with stenting from Iran society perspective.
Methods:
A retrospective study was carried out to estimate the annual cost and health related quality of life (HRQoL) of 109 patients who underwent coronary revascularization (PCI [n = 75] and CABG [n = 34]). A Markov model has been developed to determine the cost effectiveness of CABG compared with PCI. We used the model to calculate lifetime costs, life-years (LYs), and quality-adjusted life-years (QALYs) of each strategy. We also used probabilistic sensitivity analysis to test model robustness.
Results:
We found that discounted QALY lived per person in CABG versus PCI group in 5 years, 10 years, and lifetime time horizon were (3.8 ± 0.13 versus 3.88 ± 0.14), (6.4 ± 0.23 versus 6.33 ± 0.22), and (8.74 ± 0.29 versus 8.33 ± 0.27), respectively. The estimated medical cost of CABG and PCI per patient in 5 years, 10 years, and lifetime time horizon were (USD 6,819 ± 765 versus 9,011 ± 1,816), (USD 8,852 ± 1,348 versus 12,034 ± 2,375), and (USD 14,037± 4,201 versus 18,798 ± 5,821), respectively. The incremental cost-effectiveness ratio results showed CABG is a dominate alternative in 10 years and lifetime time horizon.
Conclusions:
This study demonstrated that despite higher initial cost and lower HRQoL, CABG is a cost-effective revascularization strategy compared with PCI for patients with multivessel coronary artery disease in long-term.
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