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Catheter Cardiovasc Interv. 2014 Dec 1;84(7):1029-39. doi: 10.1002/ccd.25397. Epub 2014 Feb 1.

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.

Author information

1
Department of Cardiology, Medical University of Vienna, Wahringer Gürtel 18-20, A-1090 Vienna, Austria.

Abstract

OBJECTIVES:

Cost-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.

BACKGROUND:

DES implantation reducing revascularization rate and associated costs might be attractive for health economics as compared to CABG.

METHODS:

Consecutive patients with multivessel DES-PCI (n = 114, 3.3 ± 1.2 DES/patient) or CABG (n = 85, 2.7 ± 0.9 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.

RESULTS:

Despite multiple uses for DES, in-hospital costs were significantly less for PCI than CABG, with 4551 €/patient difference between the groups. At 5-years, the overall costs remained higher for CABG patients (mean difference 5400 € 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 € or 126683 € to prevent one MACCE or AMI/death/stroke if CABG is performed.

CONCLUSIONS:

Cost-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.

KEYWORDS:

coronary artery bypass surgery; cost-benefit; drug-eluting stent; follow-up study; percutaneous coronary intervention

PMID:
24403120
PMCID:
PMC4262069
DOI:
10.1002/ccd.25397
[Indexed for MEDLINE]
Free PMC Article
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