Cost-Effectiveness of Coronary Artery Bypass Grafts Versus Percutaneous Coronary Intervention for Revascularization of High-Risk Patients

Open Access
Publisher Website
Google Scholar
Abstract
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.