Health service costs of coronary angioplasty and coronary artery bypass surgery: the Randomised Intervention Treatment of Angina (RITA) trial

Sculpher, Mark; Buxton, Martin; Seed, Paul; Pocock, Stuart J.; Henderson, Robert A.; Parker, John O.; Joy, M; Sowton, Edgar; Hampton, John R.; participants, for Rita trial

doi:10.1016/s0140-6736(94)92274-8

Cited by 86 publications

(28 citation statements)

References 14 publications

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“…The observed no difference in the incidence of death was already expected because the patients presented preserved left ventricular function, and this subset of patients presented comparable survival rate at CASS trial 1 and in other studies with PTCA, like RITA, BARI, and EAST. [2][3][4] The observed incidence of additional revascularization procedures in the PTCA group, 11.7% was similar to other PTCA-stent studies. 5 Our findings, the progressive equalization of costs between PTCA treatment and CABG, reproduced those of previous randomized studies.…”

Section: Discussionsupporting

confidence: 88%

“…The RITA trial showed that initial average cost of treating a patient randomized to PTCA was about 52% of that of CABG, but after 2 years this increased to about 80% because of the greater need for subsequent interventions. 2 Similar finding was obtained in BARI trial, which costs for PTCA increased from 65% of CABG costs to 95% of this latter treatment in 3-year follow-up. The initial difference diminished with time because the greater incidence of additional revascularization procedures in the PTCA treatment.…”

Section: Discussionsupporting

confidence: 83%

“…[1][2][3] However, usually CABG is associated to lower necessity of further revascularization procedures, mainly because of its higher proportion of patients turned asymptomatic. 1,[3][4][5] Initial costs of PTCA is usually lower to the CABG, however, additional procedures, even with the use of stents, elevate the cost so that ultimately costs are similar to CABG.…”

mentioning

confidence: 99%

“…1,[3][4][5] Initial costs of PTCA is usually lower to the CABG, however, additional procedures, even with the use of stents, elevate the cost so that ultimately costs are similar to CABG. 2,3,5 Medical treatment is less costly, however, is usually less effective for alleviating symptoms. 1 We hypothesized that the use of full medication including statins, the advent and widespread utilization of stents and the use of arterial grafts would alter the cost/benefice ratio in the treatment of stable coronary disease with preserved left ventricle function.…”

mentioning

confidence: 99%

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Relative Cost Comparison of Treatments for Coronary Artery Disease: The First Year Follow-Up of MASS II Study

Favarato

Hueb²,

Gersh³

et al. 2003

Circulation

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 83%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Relative Cost Comparison of Treatments for Coronary Artery Disease: The First Year Follow-Up of MASS II Study

Favarato

Hueb²,

Gersh³

et al. 2003

Circulation

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“…An initial cost of PCI is usually lower than that of CABG; however, additional procedures, even with the use of stents, increase the cost. [5][6][7][8] Medical treatment is less costly, although it is usually less effective for alleviating symptoms. 9 This apparent economic advantage can hide the costs applied to the long-term follow-up with repeated examinations, minor clinical interventions, clinical events involving hospitalization, or even percutaneous interventions or a surgical emergency.…”

mentioning

confidence: 99%

Cost-Effectiveness Analysis for Surgical, Angioplasty, or Medical Therapeutics for Coronary Artery Disease

et al. 2012

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Background-The Second Medicine, Angioplasty, or Surgery Study (MASS II) included patients with multivessel coronary artery disease and normal systolic ventricular function. Patients underwent coronary artery bypass graft surgery (CABG, nϭ203), percutaneous coronary intervention (PCI, nϭ205), or medical treatment alone (MT, nϭ203). This investigation compares the economic outcome at 5-year follow-up of the 3 therapeutic strategies. Methods and Results-We analyzed cumulative costs during a 5-year follow-up period. To analyze the cost-effectiveness, adjustment was made on the cumulative costs for average event-free time and angina-free proportion. Respectively, for event-free survival and event plus angina-free survival, MT presented 3.79 quality-adjusted life-years and 2.07 quality-adjusted life-years; PCI presented 3.59 and 2.77 quality-adjusted life-years; and CABG demonstrated 4.4 and 2.81 quality-adjusted life-years. The event-free costs were $9071.00 for MT; $19 967.00 for PCI; and $18 263.00 for CABG. The paired comparison of the event-free costs showed that there was a significant difference favoring MT versus PCI (PϽ0.01) and versus CABG (PϽ0.01) and CABG versus PCI (Pϭ0.01). The event-free plus angina-free costs were $16 553.00, $25 831.00, and $24 614.00, respectively. The paired comparison of the event-free plus angina-free costs showed that there was a significant difference favoring MT versus PCI (Pϭ0.04), and versus CABG (PϽ0.001); there was no difference between CABG and PCI (PϾ0.05). Conclusions-In the long-term economic analysis, for the prevention of a composite primary end point, MT was more cost effective than CABG, and CABG was more cost-effective than PCI. Clinical Trial Registration Information-www.controlled-trials.com. Registration number: ISRCTN66068876. (Circulation. 2012;126[suppl 1]:S145-S150.)

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Economic outcomes of percutaneous coronary intervention with drug‐eluting stents versus bypass surgery for patients with left main or three‐vessel coronary artery disease: One‐year results from the SYNTAX trial

Cohen

Lavelle

Hout

et al. 2011

Cathet Cardio Intervent

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Objectives: To evaluate the cost-effectiveness of alternative approaches to revascularization for patients with three-vessel or left main coronary artery disease (CAD). Background: Previous studies have demonstrated that, despite higher initial costs, long-term costs with bypass surgery (CABG) in multivessel CAD are similar to those for percutaneous coronary intervention (PCI). The impact of drug-eluting stents (DES) on these results is unknown. Methods: The SYNTAX trial randomized 1,800 patients with left main or three-vessel CAD to either CABG (n 5 897) or PCI using paclitaxeleluting stents (n 5 903). Resource utilization data were collected prospectively for all patients, and cumulative 1-year costs were assessed from the perspective of the U.S. healthcare system. Results: Total costs for the initial hospitalization were $5,693/ patient higher with CABG, whereas follow-up costs were $2,282/patient higher with PCI due mainly to more frequent revascularization procedures and higher outpatient medication costs. Total 1-year costs were thus $3,590/patient higher with CABG, while quality-adjusted life expectancy was slightly higher with PCI. Although PCI was an Additional Supporting Information may be found in the online version of this article. 1 Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri 79:198-209 (2012) economically dominant strategy for the overall population, cost-effectiveness varied considerably according to angiographic complexity. For patients with high angiographic complexity (SYNTAX score > 32), total 1-year costs were similar for CABG and PCI, and the incremental cost-effectiveness ratio for CABG was $43,486 per qualityadjusted life-year gained. Conclusions: Among patients with three-vessel or left main CAD, PCI is an economically attractive strategy over the first year for patients with low and moderate angiographic complexity, while CABG is favored among patients with high angiographic complexity. V C 2011 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions

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Health service costs of coronary angioplasty and coronary artery bypass surgery: the Randomised Intervention Treatment of Angina (RITA) trial

Cited by 86 publications

References 14 publications

Relative Cost Comparison of Treatments for Coronary Artery Disease: The First Year Follow-Up of MASS II Study

Relative Cost Comparison of Treatments for Coronary Artery Disease: The First Year Follow-Up of MASS II Study

Cost-Effectiveness Analysis for Surgical, Angioplasty, or Medical Therapeutics for Coronary Artery Disease

Economic outcomes of percutaneous coronary intervention with drug‐eluting stents versus bypass surgery for patients with left main or three‐vessel coronary artery disease: One‐year results from the SYNTAX trial

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