Coronary artery bypass grafting (CABG) can be more cost-effective over a person’s lifetime than percutaneous coronary intervention (PCI), according to findings by Christiana Care’s Center for Outcomes Research (CCOR).
CCOR Senior Biostatician Zugui Zhang, Ph.D., presented landmark results from CCOR’s follow-up to the ASCERT study at the November 2012 American Heart Association Scientific Sessions in Los Angeles.
CCOR is the analytic center for economic outcomes on ASCERT, a large observational study published in the New England Journal of Medicine last spring. It found that long-term mortality in high-risk patients is lower after bypass surgery than after PCI. The new study places adjusted lifetime costs per patient undergoing CABG at about $50,000.
With data from the Society of Thoracic Surgeons Database and the American College of Cardiology Foundation National Cardiovascular Data Registry in ASCERT, the study examined the cost-effectiveness among 86,244 CABG patients and 103,549 who underwent PCI. Using composite death outcomes data for heart attack and stroke from the Framingham Heart Study, and adjusting for treatment selection bias, the authors developed an incremental cost-effectiveness ratio expressed as cost per “quality life year gained.”
“It is highly unusual and unprecedented to employ such advanced statistical techniques in a study of this kind,” said William Weintraub, M.D., FACC, FAHA, Christiana Care’s John H. Ammon Chair of Cardiology who was lead author on the original ASCERT study and co-author on this one with Dr. Zhang and CCOR’s Director of Biostatistics Paul Kolm, Ph.D.
The investigators found that for a period of less than one year, CABG was more costly and less effective than PCI. However, in the long run, CABG offered lower mortality. For a lifetime, average total costs were $75,929 for CABG versus $65,266 for PCI, a difference of $10,663. But patients undergoing CABG gained an average of 0.18 life-years relative to PCI. Considering a common threshold for cost, based on adjusted life year gained, at $50,000, CABG will often be a cost-effective strategy.
Also at AHA
Christiana Care Cardiology fellow Kansara Pranav, M.D., presented his abstract as a poster titled “Biventricular Assist Device May be Superior to Left Ventricular Assist Device for Crash and Burn Patients.” Findings pertain to critically ill transplant candidates who match a distinct profile where subsequent progressive shock, hemorrhage and right ventricular failure are major causes of death.
Dr. Weintraub presented on “Invasive Imaging of Subclinical Disease,” and “Outpatient Versus Inpatient Percutaneous Coronary Intervention: Coverage and Reimbursement Issues.” He also moderated an “Ask the Experts” panel and participated in a plenary session panel on “The Heart Team in Action: From Evidence to Everyday Decision Making in Ischemic Heart Disease.”