Abstract | BACKGROUND: METHODS AND RESULTS: Between 2005 and 2007, 1800 patients with left main or 3-vessel coronary artery disease were randomized to CABG (n=897) or DES-PCI (n=903). Costs were assessed from a US perspective, and health state utilities were evaluated with the EuroQOL questionnaire. A patient-level microsimulation model based on the 5-year in-trial data was used to extrapolate costs, life expectancy, and quality-adjusted life expectancy over a lifetime horizon. Although initial procedural costs were $3415 per patient lower with CABG, total hospitalization costs were $10 036 per patient higher. Over the next 5 years, follow-up costs were higher with DES-PCI as a result of more frequent hospitalizations, revascularization procedures, and higher medication costs. Over a lifetime horizon, CABG remained more costly than DES-PCI, but the incremental cost-effectiveness ratio was favorable ($16 537 per quality-adjusted life-year gained) and remained <$20 000 per quality-adjusted life-year in most bootstrap replicates. Results were consistent across a wide range of assumptions about the long-term effect of CABG versus DES-PCI on events and costs. In patients with left main disease or a SYNTAX score ≤22, however, DES-PCI was economically dominant compared with CABG, although these findings were less certain. CONCLUSIONS: For most patients with 3-vessel or left main coronary artery disease, CABG is a clinically and economically attractive revascularization strategy compared with DES-PCI. However, among patients with less complex disease, DES-PCI may be preferred on both clinical and economic grounds. CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique identifier: NCT00114972.
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Authors | David J Cohen, Ruben L Osnabrugge, Elizabeth A Magnuson, Kaijun Wang, Haiyan Li, Khaja Chinnakondepalli, Duane Pinto, Mouin S Abdallah, Katherine A Vilain, Marie-Claude Morice, Keith D Dawkins, A Pieter Kappetein, Friedrich W Mohr, Patrick W Serruys, SYNTAX Trial Investigators |
Journal | Circulation
(Circulation)
Vol. 130
Issue 14
Pg. 1146-57
(Sep 30 2014)
ISSN: 1524-4539 [Electronic] United States |
PMID | 25085960
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | © 2014 American Heart Association, Inc. |
Topics |
- Aged
- Ambulatory Care
(economics)
- Coronary Artery Bypass
(economics, methods, mortality)
- Coronary Artery Disease
(economics, mortality, surgery)
- Coronary Vessels
(surgery)
- Cost-Benefit Analysis
- Drug-Eluting Stents
(economics, statistics & numerical data)
- Female
- Hospital Costs
- Humans
- Male
- Middle Aged
- Percutaneous Coronary Intervention
(economics, methods, mortality)
- Physicians
(economics)
- Quality of Life
- Quality-Adjusted Life Years
- Treatment Outcome
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