Long-term Cost-effectiveness of Endoscopic vs Open Vein Harvest for Coronary Artery Bypass Grafting

Abstract

Background: The greater saphenous vein is frequently used as a conduit for coronary artery bypass grafting (CABG). Previously, veins were most often harvested using open vein harvesting (OVH), however, endoscopic vein harvesting (EVH) techniques have become increasingly popular. Nevertheless, the long-term cost-effectiveness of EVH remains unknown. The present study estimated the long-term cost-effectiveness of EVH versus OVH for CABG.

Economic Evaluation of Endoscopic vs Open Vein Harvesting

“…This is because lower costs further downstream in the treatment pathway outweigh the initial higher investment for the EVH equipment. Our findings are in line with the results from Oddershede and Andreasen,14 who found EVH to be cost-effective, with a dominant ICER of £8219 per QALY, and the findings by Luckraz and colleagues,20 who identified cost savings of £856 per EVH patient. Similar…”

“…Specifically in the United Kingdom's National Health Service (NHS), costs per quality-adjusted life-year (QALY) gained are an important criterion in decision-making processes for the adoption of new health technologies. 11 To date, only few economic evaluations on EVH have been published, delivering different conclusions on the cost-effectiveness of EVH, 6,[12][13][14][15] while focusing only on a short-term analytic horizon. To enable more precise and informed decision making on the adoption of EVH as standard of care in the United Kingdom, 10,12 cohort only during the first cycle (transition to a different state after the first cycle).…”

“…5,20 The estimated hazard ratio for all-cause mortality was identical for patients allocated to repeat revascularization and myocardial infarction. 14 Because of the uncertainty of transition probabilities between the health states of myocardial infarction and repeat revascularization, probabilities of Oddershede and Andreasen 14 were used for the OVH cohort.…”

“…Table 1 lists the transition probabilities used. 2,8,14,17 COSTS. This study was conducted from a health care payer perspective (NHS).…”

“…For leg wound infection, we used the utility reduction of surgical site infections in the United Kingdom at 30 days postoperatively. 27 For all other health states, health-related quality of life decrements stated by Oddershede and Andreasen 14 were used. and obesity, the risk rate for leg wound complications is expected to increase as well, which can be reduced by EVH.…”