Cost-effectiveness of coronary artery bypass grafts versus percutaneous coronary intervention for revascularization of high-risk patients

被引:63
作者
Stroupe, Kevin T.
Morrison, Douglass A.
Hlatky, Mark A.
Barnett, Paul G.
Cao, Lishan
Lyttle, Christopher
Hynes, Denise M.
Henderson, William G.
机构
[1] VA Hosp, Cooperat Studies Program, Coordinating Ctr, Hines, IL 60141 USA
[2] VA Hosp, Midwest Ctr Hlth Serv & Policy Res, Hines, IL 60141 USA
[3] Feinberg Sch Med, Chicago, IL USA
[4] VA Informat Resource Ctr, Hines, IL USA
[5] Tucson VA Med Ctr, Tucson, AZ USA
[6] Univ Arizona, Tucson, AZ USA
[7] Stanford Univ, Sch Med, Stanford, CA 94305 USA
[8] VA Hlth Econ Resource Ctr, Menlo Pk, CA USA
[9] VA Cooperat Studies Program Coordinating Ctr, Palo Alto, CA USA
[10] Loyola Univ Chicago, Maywood, IL USA
[11] Univ Colorado, Hlth Outcomes Program, Aurora, CO USA
关键词
revascularization; bypass; angioplasty; cost-benefit analysis;
D O I
10.1161/CIRCULATIONAHA.105.570838
中图分类号
R5 [内科学];
学科分类号
1002 [临床医学]; 100201 [内科学];
摘要
Background-A Department of Veterans Affairs Cooperative Study randomized high-risk patients with medically refractory myocardial ischemia, a group largely excluded from previous trials, to urgent revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The present study examined the cost-effectiveness of PCI versus CABG for these high-risk patients. Methods and Results-Of 454 patients at 16 Department of Veterans Affairs medical centers, 445 were available for the economic analysis (218 PCI and 227 CABG patients). Total costs were assessed at 3 and 5 years from the third-party payer's perspective, and effectiveness was measured by survival. After 3 years, average total costs were $ 63 896 for PCI versus $ 84 364 for CABG patients, a difference of $ 20 468 (95% confidence interval [CI] $ 13 918 to $ 27 569). CIs were estimated by bootstrapping. Survival at 3 years was 0.82 for PCI versus 0.79 for CABG patients (P = 0.34). Precision of the cost-effectiveness estimates were assessed by bootstrapping. PCI was less costly and more effective at 3 years in 92.6% of the bootstrap replications. After 5 years, average total costs were $ 81 790 for PCI versus $ 100 522 for CABG patients, a difference of $ 18 732 (95% CI $ 9873 to $ 27 831), whereas survival at 5 years was 0.75 for PCI patients versus 0.70 for CABG patients (P = 0.21). At 5 years, PCI remained less costly and more effective in 89.4% of the bootstrap replications. Conclusions-PCI was less costly and at least as effective for the urgent revascularization of medically refractory, high-risk patients over 5 years.
引用
收藏
页码:1251 / 1257
页数:7
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