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Cost-effectiveness of coronary artery bypass surgery in octogenarians
J A Sollano1, E A Rose, D L Williams
1International Center for Health Outcomes and Innovation Research, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Insights
Coronary artery bypass graft (CABG) surgery in octogenarians is highly cost-effective, improving quality of life and survival compared to medical management. This elderly population benefits significantly from CABG, showing better outcomes than non-surgical options.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Health Economics
Background:
- Increasing numbers of elderly patients are undergoing coronary artery bypass graft (CABG) surgery due to population aging and surgical advancements.
- Previous randomized controlled trials (RCTs) excluded patients over 65, leaving a gap in understanding CABG outcomes, quality of life, and cost-effectiveness in the elderly.
- Existing data on CABG in octogenarians primarily comes from case series, lacking comparative effectiveness and economic analyses.
Purpose of the Study:
- To evaluate the effectiveness and cost-effectiveness of CABG surgery versus medical management for elderly patients with coronary artery disease (CAD).
- To compare survival rates and quality of life between octogenarians undergoing CABG and those receiving medical treatment.
Main Methods:
- A retrospective cohort study comparing 176 octogenarians who underwent CABG with 48 octogenarians with multivessel CAD who were suitable for surgery but received medical management.
- Medical records of over 600 patients aged 80+ were reviewed to identify study participants.
- Quality of life was assessed using the EuroQoL questionnaire, and cost-effectiveness was calculated per quality-adjusted life year (QALY) saved.
Main Results:
- The cost per quality-adjusted life year saved by CABG surgery was $10,424, indicating high cost-effectiveness.
- Three-year survival rates were 80% for the surgical group versus 64% for the overall medical cohort and 50% for a subset of the medical cohort.
- Patients undergoing CABG reported significantly better quality of life, with EuroQoL utility scores of 0.84 compared to 0.61 for the medical cohort.
Conclusions:
- Coronary artery bypass graft (CABG) surgery is a highly cost-effective intervention for octogenarians with significant multivessel coronary artery disease.
- Elderly patients undergoing CABG experience improved quality of life, comparable to that of an average 55-year-old in the general population.
- CABG surgery offers superior survival and quality of life benefits for octogenarians compared to medical management alone.
Objective:
The objective of this retrospective cohort study was to determine whether coronary artery bypass graft (CABG) surgery is effective and cost-effective relative to medical management of coronary artery disease (CAD) in the elderly.
Summary Background Data:
The aging of the U.S population and the improvements in surgical techniques have resulted in increasing numbers of elderly patients who undergo this surgery. The three randomized, controlled trials (RCTs) that established the efficacy of CABG surgery completed patient enrollment from 19 to 24 years ago excluded patients older than 65 years. Although information regarding outcomes of CABG in this population is mainly available in case series, a major lacuna exists with respect to information on quality of life and cost effectiveness of surgery as compared with medical management.
Methods:
The authors retrospectively formed surgical and medically managed cohorts of octogenarians with significant multivessel CAD. More than 600 medical records of patients older than 80 years who underwent angiography at our institution were reviewed to identify 48 patients who were considered reasonable surgical candidates but had not undergone surgery. This cohort was compared with 176 patients who underwent surgery.
Results:
The cost per quality-adjusted life year saved was $10,424. At 3 years, survival in the surgical group was 80% as compared with 64% in the entire medical cohort and 50% in a smaller subset of the medical cohort. Quality of life in patients who underwent surgery was measurably better than that of the medical cohort with utility index scores, as measured by the EuroQoL, (a seven-item quality of life questionnaire) of 0.84, 0.61, and 0.74, respectively.
Conclusions:
Performing CABG surgery in octogenarians is highly cost-effective. The quality of life of the elderly who elect to undergo CABG surgery is greater than that of their cohorts and equal to that of an average 55-year-old person in the general population.
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