Coronary Bypass Surgery Versus Percutaneous Coronary Intervention: Cost-Effectiveness in Iran: a Study In Patients With Multivessel Coronary Artery Disease

Mehdi Javanbakht, Razieh Yazdani Bakhsh, Atefeh Mashayekhi, Hossein Ghaderi, Masoumeh Sadeghi

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)366-373
Number of pages8
JournalInternational Journal of Technology Assessment in Health Care
Volume30
Issue number4
DOIs
Publication statusPublished - Oct 2014

Keywords

  • cost effectiveness analysis
  • percutaneous coronary intervention
  • coronary artery bypass grafting
  • Iran
  • quality adjusted life years

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