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Coronary Bypass Surgery Versus Percutaneous Coronary Intervention: Cost-Effectiveness in Iran: A Study in Patients With Multivessel Coronary Artery Disease Publisher Pubmed



Javanbakht M1 ; Bakhsh RY2 ; Mashayekhi A3 ; Ghaderi H4 ; Sadeghi M5
Authors
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Authors Affiliations
  1. 1. Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
  2. 2. Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Health Economics Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
  5. 5. Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical sciences, Isfahan, Iran

Source: International Journal of Technology Assessment in Health Care Published:2014


Abstract

Objectives: The aim of this study was to evaluate cost effectiveness of coronary artery bypass graft (CABG) versus percutaneous coronary intervention (PCI) with stenting from Iran society perspective. Methods: A retrospective study was carried out to estimate the annual cost and health related quality of life (HRQoL) of 109 patients who underwent coronary revascularization (PCI [n = 75] and CABG [n = 34]). A Markov model has been developed to determine the cost effectiveness of CABG compared with PCI. We used the model to calculate lifetime costs, life-years (LYs), and quality-adjusted life-years (QALYs) of each strategy. We also used probabilistic sensitivity analysis to test model robustness. Results: We found that discounted QALY lived per person in CABG versus PCI group in 5 years, 10 years, and lifetime time horizon were (3.8 ± 0.13 versus 3.88 ± 0.14), (6.4 ± 0.23 versus 6.33 ± 0.22), and (8.74 ± 0.29 versus 8.33 ± 0.27), respectively. The estimated medical cost of CABG and PCI per patient in 5 years, 10 years, and lifetime time horizon were (USD 6,819 ± 765 versus 9,011 ± 1,816), (USD 8,852 ± 1,348 versus 12,034 ± 2,375), and (USD 14,037± 4,201 versus 18,798 ± 5,821), respectively. The incremental cost-effectiveness ratio results showed CABG is a dominate alternative in 10 years and lifetime time horizon. Conclusions: This study demonstrated that despite higher initial cost and lower HRQoL, CABG is a cost-effective revascularization strategy compared with PCI for patients with multivessel coronary artery disease in long-term. © Cambridge University Press 2014.
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