One year comparison of costs of coronary surgery versus percutaneous coronary intervention in the stent or surgery trial

Abstract

Objectives: To compare initial and one year costs of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in the stent or surgery trial. Design: Prospective, unblinded, randomised trial. Setting: Multicentre study. Patients: 988 patients with multivessel disease. Interventions: CABG and stent assisted PCI. Main outcome measures: Initial hospitalisation and one year follow up costs. Results: At one year mortality was 2.5% in the PCI arm and 0.8% in the CABG arm (p = 0.05). There was no difference in the composite of death or Q wave myocardial infarction (6.9% for PCI v 8.1% for CABG, p = 0.49). There were more repeat revascularisations with PCI (17.2% v 4.2% for CABG). There was no significant difference in utility between arms at six months or at one year. Quality adjusted life years were similar 0.6938 for PCI v 0.6954 for PCI, D = 0.00154, 95% confidence interval (CI) 20.0242 to 0.0273). Initial length of stay was longer with CABG (12.2 v 5.4 days with PCI, p , 0.0001) and initial hospitalisation costs were higher (£7321 v £3884 for PCI, D = £3437, 95% CI £3040 to £3848). At one year the cost difference narrowed but costs remained higher for CABG (£8905 v £6296 for PCI, D = £2609, 95% CI £1769 to £3314). Conclusions: Over one year, CABG was more expensive and offered greater survival than PCI but little added benefit in terms of quality adjusted life years. The additional cost of CABG can be justified only if it offers continuing benefit at no further increase in cost relative to PCI over several years.

Revascularização do miocárdio: estudo comparativo do custo da cirurgia convencional e da angioplastia transluminal percutânea

“…Considering the group of patients for each procedure, the hospitalization costs of Group 1 were 12.3% greater than those of Group 2, thereby corroborating with other published works. However, the percentage increase in respect to CABG of the present sample, is less than the increases reported by Favarato et al (35.9%) [10], in the ARTS study (65.4%) [9] and Weintraub et al (88.5%) [24].…”

Randomized, Controlled Trial of Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease

“…2,[11][12][13] Patients were recruited from 53 study centers in 11 European countries and Canada between November 5, 1996, and December 12, 1999. Patients with multivessel coronary artery disease were considered for inclusion and enrolled if the consensus view of the trial surgeon and interventionist was that revascularization was clinically indicated and appropriate by either strategy.…”

Cost-Effectiveness of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Bypass Surgery for Patients With 3-Vessel or Left Main Coronary Artery Disease

“…7,9,15,28,[35][36][37][38][39] However, most of these studies are limited by relatively short follow-up durations 7,34,36,39 or Costs and QALYs are discounted at 3% per year. Δ indicates difference between CABG and PCI groups; CABG, coronary artery bypass grafting; CI, confidence interval; ICER, incremental cost-effectiveness ratio for coronary artery bypass grafting versus percutaneous coronary intervention; LM, left main; PCI, percutaneous coronary intervention; QALY, quality-adjusted life-year gained; and SYNTAX, Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery.…”