Treatment for Stable Coronary Artery Disease: A Network Meta-Analysis of Cost-Effectiveness Studies

Abstract

Introduction and ObjectivesNumerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG).MethodsRCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs.ResultsFifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3-year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG.ConclusionsAppreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina.

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…PCI costs were between medical therapy and CABG costs and were higher with DES than with bare-metal stents and balloon angioplasty. 59 …”

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“…The costs of CVD events and costs of treatments were derived from recent literature. [13][14][15][16] The costs of each procedure (i.e., CABG or PTCA) included procedural and physician fees as well as costs for hospital stays and ancillary services. For procedures following the CHD state, we considered costs for re-hospitalization, outpatient and rehabilitation services, medication, and physician fees.…”

“…For procedures following the CHD state, we considered costs for re-hospitalization, outpatient and rehabilitation services, medication, and physician fees. [14] The costs for medical therapy and emergency admission for MI were used for the "no procedure" outcome. For the costs for direct death due to MI, we included physician fees, hospital stay expenses and ancillary services.…”

Advances in non-invasive drug delivery for atherosclerotic heart disease

“…On the other hand, hardly 30 --35% of CHD cases may consistently benefit from statin treatment. In regards to the invasive methods of CHD treatment, there is no clear-cut evidence in the literature that revascularization surgeries or PCIs, whatever performed with bare-metal or with drug-eluting stents, have the ability to significantly diminish MACE in comparison with the current medical treatment [93,94]. Therefore, there is a need to develop effective treatments.…”