Coronary Bypass Surgery Versus Percutaneous Coronary Intervention: Cost-Effectiveness in Iran: A Study in Patients With Multivessel Coronary Artery Disease

Javanbakht, Mehdi; Bakhsh, Razieh Yazdani; Mashayekhi, Atefeh; Ghaderi, Hossein; Sadeghi, Masoumeh

doi:10.1017/s0266462314000439

Cited by 8 publications

(11 citation statements)

References 22 publications

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“…Our results reveal that in the short-term, CABG costs less than PCI and has a better prognosis among CAD patients with stable triple-vessel or left-main. This result of the study was consistent with some randomized clinical trials (RCT) and observational studies reported by previous economic and clinical outcomes [13][14][15].…”

Section: Discussionsupporting

confidence: 92%

Economic Analysis of Surgical and Interventional Treatments for Patients with Complex Coronary Artery Disease: Insights from a One-Year Single-Center Study

et al. 2020

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Departmental sources Background:Surgical treatment methods for patients with complex coronary artery disease (CAD) who have undergone vascular reconstruction mainly include coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). The purpose of the study aimed to compare a 1-year follow-up for the patient clinical outcomes and costs between PCI and CABG treatment. Material/Methods: There were 840 patients enrolled in this study from July 2015 to September 2016. Among the study participants, 420 patients underwent PCI treatment and 420 patients underwent off-pump CABG. Patients costs were assessed from the perspective of the China healthcare and medical insurance system. EuroQOL 5-dimension 3 levels (EQ-5D-3L) questionnaire was used to evaluate the general health status, and the Seattle Angina Questionnaire (SAQ) was used to assess the disease-specific health status. Results:After a 1-year follow-up, the all-cause mortality (P=0.0337), the incidence of major adverse cardiac and cerebrovascular events (P<0.001), and additional revascularization (P<0.001) in PCI group were significantly higher than those in CABG group. Both groups have significant sustained benefits in the SAQ subscale. The CABG group had a higher score on the frequency of angina than the PCI group. In addition, the quality-adjusted life year value of PCI and CABG resulted was 0.8. The average total cost for PCI was $14 643 versus CABG cost of $13 842 (P=0.0492). Conclusions:In the short-term, among the CAD patients with stable triple-vessel or left-main, costs and clinical outcomes are substantially higher for CABG than PCI. Long-term, economic, and health benefits analysis, is warranted.

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Section: Discussionsupporting

confidence: 92%

Economic Analysis of Surgical and Interventional Treatments for Patients with Complex Coronary Artery Disease: Insights from a One-Year Single-Center Study

et al. 2020

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“…Nevertheless, patients selected for both procedures are not representative of multivessel disease because 41% of them had single-vessel disease and just 8% were triple-vessel disease patients [ 20 ]. More recently, a study was carried out by the Iran society perspective to evaluate PCI with stents versus CABG in patients with triple-vessel disease [ 21 ]. Contrary to our findings, it found that CABG is a cost-effective strategy compared with PCI, whereas this study included a small and unbalanced sample size, and cardiovascular events were not included in the Markov model over 5 years, 10 years, and life-time horizon.…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to our findings, it found that CABG is a cost-effective strategy compared with PCI, whereas this study included a small and unbalanced sample size, and cardiovascular events were not included in the Markov model over 5 years, 10 years, and life-time horizon. Instead, it used a specific questionnaire to measure QALY, which makes it difficult to compare with other studies [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Comparative cost-effectiveness of surgery, angioplasty, or medical therapy in patients with multivessel coronary artery disease: MASS II trial

Brandão

Rezende

Rocca

et al. 2018

Cost Eff Resour Alloc

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BackgroundThe costs for treating coronary artery disease (CAD) are high worldwide. We performed a prespecified analyses of cost-effectiveness of three therapeutic strategies for multivessel CAD.MethodsFrom May 1995 to May 2000, a total of 611 patients were randomly assigned to coronary artery bypass graft (CABG), n = 203; percutaneous coronary intervention (PCI), n = 205; or medical treatment (MT), n = 203. This cost analysis study was based on the perspective of the Public Health Care System. Initial procedural and follow-up costs for medications, cardiology examinations, and hospitalizations for complications were calculated after randomization. Life-years and quality-adjusted life years (QALYs) were used as effectiveness measures. Incremental cost-effectiveness ratios (ICER) were obtained by using nonparametric bootstrapping methods with 5000 resamples.ResultsInitial procedural costs were lower for MT. However, the subsequent 5-year cumulative costs were lower for CABG. Compared with baseline, the three treatment options produced significant improvements in QALYs. After 5 years, PCI and CABG had better QALYs results compared with MT. The ICER results favored CABG and PCI, and favored PCI over CABG in 61% of the drawings. On the other hand, sensitivity analysis showed MT as the preferred therapy compared with CABG and PCI, in the analysis considering higher costs.ConclusionsAt 5-year follow-up, the three treatment options yielded improvements in quality of life, with comparable and acceptable costs. However, despite higher initial costs, the comparison of cost-effectiveness after 5 years of follow-up among the three treatments showed both interventions (CABG and PCI) to be cost-effective strategies compared with MT.Trial registration ISRCTN, ISRCTN66068876, Registered 06/10/1994, http://www.controlled-trials.com/ISRCTN66068876Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0158-z) contains supplementary material, which is available to authorized users.

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“…Coronary bypass surgery (CBAG) in patients with multi-vessel coronary artery disease [28] and, tissue plasminogen activator in patients with ischemic stroke [29] are cost effective interventions from society and thirdparty perspective, respectively. Moreover, homograft valve in patients that underwent homograft and mechanical heart valve replacement surgery is a cost effective intervention [30].…”

Section: Coronary Artery Diseasementioning

confidence: 99%

QALY league table of Iran: a practical method for better resource allocation

Hashempour

Raei

Lari

et al. 2021

Cost Eff Resour Alloc

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Background The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table. Methods A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal. Results In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45% of the reviewed studies. Discount rates ranged from zero to 7.2%. The cost per QALY ranged from $ 0.144 in radiography costs for patients with some orthopedic problems to $ 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR. Conclusions However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran.

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Coronary Bypass Surgery Versus Percutaneous Coronary Intervention: Cost-Effectiveness in Iran: A Study in Patients With Multivessel Coronary Artery Disease

Abstract: 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.

Cited by 8 publications

References 22 publications

Economic Analysis of Surgical and Interventional Treatments for Patients with Complex Coronary Artery Disease: Insights from a One-Year Single-Center Study

Economic Analysis of Surgical and Interventional Treatments for Patients with Complex Coronary Artery Disease: Insights from a One-Year Single-Center Study

Comparative cost-effectiveness of surgery, angioplasty, or medical therapy in patients with multivessel coronary artery disease: MASS II trial

QALY league table of Iran: a practical method for better resource allocation

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