Medical Care Costs and Quality of Life after Randomization to Coronary Angioplasty or Coronary Bypass Surgery

Mark, Daniel B.; Rogers, William J.; Johnstone, Iain M.; Boothroyd, Derek; Brooks, Maria M.; Pitt, Bertram; Reeder, Guy S.; Ryan, Thomas J.; Smith, Hugh C.; Whitlow, Patrick L.; Wiens, Robert D.; Mark, Daniel B.; Rosen, Allan D.; Detre, Katherine M.; Frye, Robert L.

doi:10.1056/nejm199701093360203

Cited by 300 publications

(181 citation statements)

References 37 publications

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“…The C/E studies of revascularization for patients with stable angina included one based solely on modeling from secondary data (77) and one based directly on a clinical trial (29). Using decision analysis with a Markov model, Wong et al assessed the incremental cost effectiveness of angioplasty (PTCA) compared with medical therapy and CABG in different patients (77).…”

Section: Coronary Heart Diseasementioning

confidence: 99%

“…The Bypass Angioplasty Revascularization Investigation followed the Wong analysis in 1997, and its results were quite different (29). This Investigation was a randomized experiment comparing PTCA and CABG, on an intentionto-treat basis, in patients with disease of one or two coronary vessels.…”

Section: Coronary Heart Diseasementioning

confidence: 99%

“…Thus, the gains in life expectancy for both PCTA and CABG were probably underestimated. Subject to this limitation, but with the advantage of primary data from a randomized trial, Hlatky et al (29) found that CABG was somewhat more expensive and more effective than PCTA, at an incremental C/E ratio of $26,000 per LY.…”

Section: Coronary Heart Diseasementioning

confidence: 99%

“…The number of LYs was the metric of health outcome used in all the primary and secondary prevention CEAs (17,24,29,66). The analyses of tertiary prevention measures were more likely to use QALYs (29,39,45). Quality weights were likely to be based on physician or patient (rather than community) preferences (77).…”

Section: Coronary Heart Diseasementioning

confidence: 99%

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Evaluating the Cost-Effectiveness of Clinical and Public Health Measures

Graham

Corso

Morris

et al. 1998

Annu. Rev. Public Health

133

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Cost-effectiveness analysis, an analytic tool that expresses as a ratio the cost of obtaining an additional unit of health outcome, can help decision makers achieve more health protection for the same or less cost. We characterize the state of the cost-effectiveness analysis literature by reviewing how this technique is applied to various clinical and public health interventions. We describe the results of cost-effectiveness analyses for over 40 interventions to reduce cancer, heart disease, trauma, and infectious disease. The cost-effectiveness ratios for these interventions vary enormously, from interventions that save money to those that cost more than $1 million per year of life gained. The methods used to derive the cost-effectiveness ratios also vary considerably, and we summarize this variation within each health area. Greater uniformity of analytical practice will be necessary if cost-effectiveness analysis is to become a more influential tool in debates about resource allocation.

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Section: Coronary Heart Diseasementioning

confidence: 99%

Section: Coronary Heart Diseasementioning

confidence: 99%

Section: Coronary Heart Diseasementioning

confidence: 99%

Section: Coronary Heart Diseasementioning

confidence: 99%

See 2 more Smart Citations

Evaluating the Cost-Effectiveness of Clinical and Public Health Measures

Graham

Corso

Morris

et al. 1998

Annu. Rev. Public Health

133

View full text Add to dashboard Cite

show abstract

“…In the late 1990 s, Hlatky et al showed that long-term cognitive function was similar after CABG surgery and coronary angioplasty in the majority of patients. 19 The International Study of Postoperative Cognitive Dysfunction (ISPOCD) group 20 showed that POCD was present in 10.4% of elderly patients one to two years after non-cardiac surgery. This rate of cognitive decline was almost identical (10.6%) to the age-adjusted non-surgical controls tested at the same time interval.…”

Section: Discussionmentioning

confidence: 99%

Early benefit of preserved cognitive function is not sustained at one-year after cardiac surgery: a longitudinal follow-up of the randomized controlled trial

Djaiani

Katznelson

Fedorko

et al. 2012

Can J Anesth/J Can Anesth

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Recovery Expectations and Long-term Prognosis of Patients With Coronary Heart Disease

Barefoot¹,

Brummett²,

Williams³

et al. 2011

Arch Intern Med

Self Cite

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Background Expectations of patients regarding their prospects for recovery have been shown to predict subsequent physical and social functioning. Evidence regarding the impact of expectations on clinical outcomes is limited. Methods At the inpatient service of a tertiary care hospital, we evaluated beliefs of patients undergoing coronary angiography about their prognosis as predictors of long-term survival and 1-year functional status. Baseline assessments, including a measure of expectations for recovery, were obtained during hospitalization with mortality follow-up for approximately 15 years. Patients with significant obstructive coronary artery disease were interviewed while in the hospital and enrolled in follow-up. Functional status was assessed at baseline and 1 year later with questionnaires reflecting physical capabilities. Analyses controlled for age, sex, disease severity, comorbidities, treatments, demographics, depressive symptoms, social support, and functional status. There were 1637 total deaths, 885 from cardiovascular causes, in the 2818 patients in these analyses. The outcomes were total mortality, cardiovascular mortality, and 1-year functional status. Results Expectations were positively associated with survival after controlling for background and clinical disease indicators. For a difference equivalent to an inter-quartile range of expectations, the hazard ratio (HR) for total mortality was 0.76 (95% confidence interval [CI], 0.71–0.82) and 0.76 (95% CI, 0.69–0.83) for cardiovascular mortality. The HRs were 0.83 (95% CI, 0.76–0.91) and 0.79 (95% CI, 0.70–0.89) with further adjustments for demographic and psychosocial covariates. Similar associations (P<.001) were observed for functional status. Conclusion Recovery expectations at baseline were positively associated with long-term survival and functioning in patients with coronary artery disease.

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Medical Care Costs and Quality of Life after Randomization to Coronary Angioplasty or Coronary Bypass Surgery

Cited by 300 publications

References 37 publications

Evaluating the Cost-Effectiveness of Clinical and Public Health Measures

Evaluating the Cost-Effectiveness of Clinical and Public Health Measures

Early benefit of preserved cognitive function is not sustained at one-year after cardiac surgery: a longitudinal follow-up of the randomized controlled trial

Recovery Expectations and Long-term Prognosis of Patients With Coronary Heart Disease

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