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Cost-effectiveness of revascularization strategies: the ASCERT study

Zugui Zhang1, Paul Kolm1, Maria V Grau-Sepulveda2

  • 1Value Institute, Christiana Care Health System, Newark, Delaware.

Journal of the American College of Cardiology
|January 10, 2015
PubMed

Insights

Coronary artery bypass graft (CABG) offers better long-term outcomes than percutaneous coronary intervention (PCI) for coronary artery disease, despite higher initial costs. CABG provides improved life-years gained, making it a valuable consideration for patient care.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Interventional Cardiology

Background:

  • The ASCERT study compared long-term effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for coronary artery disease (CAD).
  • Focus on patients aged 65+ with 2- or 3-vessel coronary artery disease.

Purpose of the Study:

  • To evaluate the cost-effectiveness of CABG versus PCI in patients with stable ischemic heart disease.
  • To compare long-term outcomes and healthcare expenditures associated with each revascularization strategy.

Main Methods:

  • Linked STS/ACC-F databases with CMS claims data for cost assessment.
  • Utilized propensity score matching to adjust for baseline differences between CABG and PCI groups.
  • Measured effectiveness through mortality and life-expectancy data, calculating cost per quality-adjusted life-year (QALY) gained.

Main Results:

  • CABG patients (n=86,244) incurred higher adjusted costs: $10,670 (index hospitalization), $8,145 (study period), and $11,575 (lifetime).
  • CABG patients gained an average of 0.2525 life-years (observation period) and 0.3801 life-years (lifetime) compared to PCI patients (n=103,549).
  • The lifetime incremental cost-effectiveness ratio for CABG versus PCI was $30,454 per QALY gained.

Conclusions:

  • Over 4+ years, CABG demonstrates superior patient outcomes compared to PCI for coronary artery disease.
  • The improved effectiveness of CABG is associated with increased healthcare costs.
  • The findings provide crucial data for decision-making regarding revascularization strategies in older adults with complex CAD.
Abstract

Keywords:
coronary artery bypass graftincremental cost-effectiveness ratiopercutaneous coronary interventionstable ischemic heart disease

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