Cost-effectiveness of bypass surgery versus stenting in patients with multivessel coronary artery disease

Yock, Cynthia A; Boothroyd, Derek B; Owens, Douglas K; Garber, Alan M; Hlatky, Mark A

doi:10.1016/S0002-9343(03)00296-1

Next »The American Journal of Medicine
Volume 115, Issue 5 , Pages 382-389, 1 October 2003

Cost-effectiveness of bypass surgery versus stenting in patients with multivessel coronary artery disease☆

Cynthia A Yock, MS
- Center for Primary Care and Outcomes Research (CAY, DKO, AMG), Stanford University School of Medicine, Stanford, California, USA
Derek B Boothroyd, PhD
- Department of Health Research and Policy (DBB, DKO, AMG, MAH), Stanford University School of Medicine, Stanford, California, USA
Douglas K Owens, MD, MS
- Center for Primary Care and Outcomes Research (CAY, DKO, AMG), Stanford University School of Medicine, Stanford, California, USA
- Department of Health Research and Policy (DBB, DKO, AMG, MAH), Stanford University School of Medicine, Stanford, California, USA
- Veterans’ Administration Health Care System (DKO, AMG), Palo Alto, California, USA
Alan M Garber, MD, PhD
- Center for Primary Care and Outcomes Research (CAY, DKO, AMG), Stanford University School of Medicine, Stanford, California, USA
- Department of Health Research and Policy (DBB, DKO, AMG, MAH), Stanford University School of Medicine, Stanford, California, USA
Mark A Hlatky, MD
- Department of Health Research and Policy (DBB, DKO, AMG, MAH), Stanford University School of Medicine, Stanford, California, USA
- Veterans’ Administration Health Care System (DKO, AMG), Palo Alto, California, USA
- Requests for reprints should be addressed to Mark A. Hlatky, MD, Stanford University School of Medicine, HRP Redwood Building, Room 150, Stanford, California 94305-5405, USA

Received 1 November 2002; accepted 27 February 2003.

Abstract

Purpose

To compare the cost-effectiveness of surgical and angioplasty-based coronary artery revascularization techniques, in particular, angioplasty with primary stenting.

Methods

We used data from the Study of Economics and Quality of Life, a substudy of the Bypass Angioplasty Revascularization Investigation (BARI), to measure the outcomes and costs of angioplasty and bypass surgery in patients with multivessel coronary artery disease who had not undergone prior coronary artery revascularization. Using a Markov decision model, we updated the outcomes and costs to reflect technology changes since the time of enrollment in BARI, and projected the lifetime costs and quality-adjusted life-years (QALYs) for the two procedures from the time of initial treatment through death. We accounted for the effects of improved procedural safety and efficiency, and prolonged therapeutic effects of both surgery and stenting. This study was conducted from a societal perspective.

Results

Surgical revascularization was less costly and resulted in better outcomes than catheter-based intervention including stenting. It remained the preferred strategy after adjusting the stent outcomes to eliminate the costs and events associated with target lesion restenosis. Among angioplasty-based strategies, primary stent use cost an additional $189,000 per QALY gained compared with a strategy that reserved stent use for treatment of suboptimal balloon angioplasty results.

Conclusion

Bypass surgery results in better outcomes than angioplasty in patients with multivessel disease, and at a lower cost.

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☆ Supported by Grant 15151 from the Robert Wood Johnson Foundation, Princeton, New Jersey, and by Grant HL-58324 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

PII: S0002-9343(03)00296-1

doi:10.1016/S0002-9343(03)00296-1

Next »The American Journal of Medicine
Volume 115, Issue 5 , Pages 382-389, 1 October 2003

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