Cost-Effectiveness of Percutaneous Coronary Intervention With Drug-Eluting Stents in Patients With Multivessel Coronary Artery Disease Compared to Coronary Artery Bypass Surgery Five-Years After Intervention

被引：20

作者：

Krenn, Lisa ^{[1
]}

Kopp, Christoph ^{[1
]}

Glogar, Dietmar ^{[1
]}

Lang, Irene M. ^{[1
]}

Delle-Karth, Georg ^{[1
]}

Neunteufl, Thomas ^{[1
]}

Kreiner, Gerhard ^{[1
]}

Kaider, Alexandra ^{[2
]}

Bergler-Klein, Jutta ^{[1
]}

Khorsand, Aliasghar ^{[1
]}

Nikfardjam, Mariam ^{[1
]}

Laufer, Guenther ^{[3
]}

Maurer, Gerald ^{[1
]}

Gyoengyoesi, Mariann ^{[1
]}

机构：

[1] Med Univ Vienna, Dept Cardiol, A-1090 Vienna, Austria

[2] Ctr Med Stat Informat & Intelligent Syst, Sect Clin Biometr, A-1090 Vienna, Austria

[3] Med Univ Vienna, Dept Cardiac Surg, A-1090 Vienna, Austria

来源：

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS | 2014年 / 84卷 / 07期

关键词：

coronary artery bypass surgery; percutaneous coronary intervention; drug-eluting stent; cost-benefit; follow-up study; RANDOMIZED CONTROLLED-TRIAL; LEFT MAIN; CARDIAC-SURGERY; SYNTAX SYNERGY; REVASCULARIZATION; OUTCOMES; TAXUS; ANGIOPLASTY; PREDICTION; 3-VESSEL;

D O I：

10.1002/ccd.25397

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

ObjectivesCost-effectiveness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES), and coronary artery bypass surgery (CABG) was analyzed in patients with multivessel coronary artery disease over a 5-year follow-up. BackgroundDES implantation reducing revascularization rate and associated costs might be attractive for health economics as compared to CABG. MethodsConsecutive patients with multivessel DES-PCI (n=114, 3.31.2 DES/patient) or CABG (n=85, 2.70.9 grafts/patient) were included prospectively. Primary endpoint was cost-benefit of multivessel DES-PCI over CABG, and the incremental cost-effectiveness ratio (ICER) was calculated. Secondary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE), including acute myocardial infarction (AMI), all-cause death, revascularization, and stroke. ResultsDespite multiple uses for DES, in-hospital costs were significantly less for PCI than CABG, with 4551 Euro/patient difference between the groups. At 5-years, the overall costs remained higher for CABG patients (mean difference 5400 Euro between groups). Cost-effectiveness planes including all patients or subgroups of elderly patients, diabetic patients, or Syntax score >32 indicated that CABG is a more effective, more costly treatment mode for multivessel disease. At the 5-year follow-up, a higher incidence of MACCE (37.7% vs. 25.8%; log rank P=0.048) and a trend towards more AMI/death/stroke (25.4% vs. 21.2%, log rank P=0.359) was observed in PCI as compared to CABG. ICER indicated 45615 Euro or 126683 Euro to prevent one MACCE or AMI/death/stroke if CABG is performed. ConclusionsCost-effectiveness analysis of DES-PCI vs. CABG demonstrated that CABG is the most effective, but most costly, treatment for preventing MACCE in patients with multivessel disease. (c) 2014 Wiley Periodicals, Inc.

引用

页码：1029 / 1039

页数：11

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