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Published on: September 15, 2023
Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Medicine in Ischemic Cardiomyopathy: The STICH Randomized
Derek S Chew1,2,3, Patricia A Cowper1, Hussein Al-Khalidi1,4
1Duke Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D., L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC.
Insights
Coronary artery bypass grafting (CABG) is economically favorable for ischemic cardiomyopathy patients compared to medical therapy (MED). The STICH trial showed CABG offers long-term survival benefits and cost-effectiveness in the US healthcare system.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Clinical Trials
Background:
- The STICH trial found coronary artery bypass grafting (CABG) reduced 10-year mortality versus medical therapy (MED) in ischemic cardiomyopathy patients with reduced ejection fraction (≤35%).
- This study analyzes the economic implications of the STICH trial findings.
Purpose of the Study:
- To estimate the lifetime costs and benefits of CABG compared to MED.
- To determine the cost-effectiveness of CABG in patients with ischemic cardiomyopathy.
Main Methods:
- A decision-analytic patient-level simulation model was used.
- Data from the STICH trial on patient-level resource use and clinical outcomes were utilized.
- US cost weights were applied, and a 3% discount rate was used for future costs and benefits.
Main Results:
- CABG resulted in 6.53 quality-adjusted life-years (QALYs) and a lifetime cost of $140,059.
- Medical therapy (MED) yielded 5.52 QALYs and a lifetime cost of $74,894.
- The incremental cost-effectiveness ratio (ICER) for CABG was $63,989 per QALY gained, considered economically favorable at a $100,000/QALY threshold.
Conclusions:
- Coronary artery bypass grafting (CABG) is an economically attractive treatment option compared to medical therapy (MED) for patients with ischemic cardiomyopathy and reduced left ventricular function.
- These findings support the value of CABG within current US healthcare benchmarks.
Background:
The STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure) demonstrated that coronary artery bypass grafting (CABG) reduced all-cause mortality rates out to 10 years compared with medical therapy alone (MED) in patients with ischemic cardiomyopathy and reduced left ventricular function (ejection fraction ≤35%). We examined the economic implications of these results.
Methods:
We used a decision-analytic patient-level simulation model to estimate the lifetime costs and benefits of CABG and MED using patient-level resource use and clinical data collected in the STICH trial. Patient-level costs were calculated by applying externally derived US cost weights to resource use counts during trial follow-up. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective.
Results:
For the CABG arm, we estimated 6.53 quality-adjusted life-years (95% CI, 5.70-7.53) and a lifetime cost of $140 059 (95% CI, $106 401 to $180 992). For the MED arm, the corresponding estimates were 5.52 (95% CI, 5.06-6.09) quality-adjusted life-years and $74 894 lifetime cost (95% CI, $58 372 to $93 541). The incremental cost-effectiveness ratio for CABG compared with MED was $63 989 per quality-adjusted life-year gained. At a societal willingness-to-pay threshold of $100 000 per quality-adjusted life-year gained, CABG was found to be economically favorable compared with MED in 87% of microsimulations.
Conclusions:
In the STICH trial, in patients with ischemic cardiomyopathy and reduced left ventricular function, CABG was economically attractive relative to MED at current benchmarks for value in the United States.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT00023595.
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