Volume 2, Issue 1 (Winter 2021)
J Vessel Circ 2021, 2(1): 33-42 |
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Ebadi Fard Azar F, Sheikh Gholami S, razapour A. Coronary Artery Bypass Graft Compared to Percutaneous Coronary Interventions in Patients With Coronary Artery Disease: A Cost-Effectiveness Analysis. J Vessel Circ 2021; 2 (1) :33-42
URL: http://jvessels.muq.ac.ir/article-1-97-en.html
URL: http://jvessels.muq.ac.ir/article-1-97-en.html
1- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran., School of Health Management and Information Sciences, No. 6, Rashid Yasemi St. Vali –e Asr Ave, Tehran, Iran.
2- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran., School of Health Management and Information Sciences, No. 6, Rashid Yasemi St. Vali –e Asr Ave, Tehran, Iran.
2- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran., School of Health Management and Information Sciences, No. 6, Rashid Yasemi St. Vali –e Asr Ave, Tehran, Iran.
Abstract: (1331 Views)
Background and Aim: Coronary Artery Diseases (CADs) affect different physical, social, and economic aspects of patients’ lives. The cost-effectiveness analysis is a way to examine both the costs and health outcomes of one or more therapeutic interventions of this disease. In other words, it compares an intervention to another one by estimating how much it costs to gain a unit of a health outcome, for instance, a life-year gained or death prevented. This study aimed to compare Coronary Artery Bypass Graft (CABG) with Percutaneous Coronary Intervention (PCI) in patients with CADs.
Materials and Methods: This study is descriptive-analytical. It was conducted on 601 patients who underwent CABG (n=287) and PCI (n=314) in three aspects. The first aspect is to measure the effectiveness of CABG and PCI (cardiac mortality rate and quality of life). The second aspect is to estimate the direct costs (e.g. medical and non-medical costs) and indirect costs (e.g. productivity losses due to morbidity and mortality) based on a societal perspective. The third aspect is the cost-effectiveness analysis. The obtained data were analyzed with Markov cohort simulation using Excel and the TreeAge tool. Uncertainties related to model parameters were evaluated using 1-way and 2-way sensitivity analyses.
Results: During the follow-up period, 2% and 0.8% of patients died after CABG and PCI intervention, respectively. The Mean±SD EuroQol- 5 Dimension (EQ-5D) score after 12 months was 0.72±0.15 for the CABG group and 0.66±0.19 for the PCI group. All the therapeutic strategies yielded significant improvement in all dimensions during the follow-up. The mean annual total cost for the overall sample was $6243 per patient. This cost was significantly higher among patients who underwent CABG ($7234 per patient) than PCI ($5252 per patient). Direct costs accounted for 90%, and indirect costs accounted for 10% of the total costs. And the cost-effectiveness threshold was $14375. The Incremental Cost-Effectiveness Rate (ICER) in reducing mortality rate and increasing Quality of Life (QoL) was $-942.7 and $106050, respectively.
Conclusion: The present study found which intervention (PCI and CABG) had better cost-effectiveness in CAD patients. PCI intervention is more cost-effective than CABG in reducing mortality rate and increasing quality of life. This study tries to resolve the previous controversies regarding the most appropriate treatment for patients with coronary artery disease. It can have significant policy and clinical implications for health policymakers, cardiologists, and health managers.
Materials and Methods: This study is descriptive-analytical. It was conducted on 601 patients who underwent CABG (n=287) and PCI (n=314) in three aspects. The first aspect is to measure the effectiveness of CABG and PCI (cardiac mortality rate and quality of life). The second aspect is to estimate the direct costs (e.g. medical and non-medical costs) and indirect costs (e.g. productivity losses due to morbidity and mortality) based on a societal perspective. The third aspect is the cost-effectiveness analysis. The obtained data were analyzed with Markov cohort simulation using Excel and the TreeAge tool. Uncertainties related to model parameters were evaluated using 1-way and 2-way sensitivity analyses.
Results: During the follow-up period, 2% and 0.8% of patients died after CABG and PCI intervention, respectively. The Mean±SD EuroQol- 5 Dimension (EQ-5D) score after 12 months was 0.72±0.15 for the CABG group and 0.66±0.19 for the PCI group. All the therapeutic strategies yielded significant improvement in all dimensions during the follow-up. The mean annual total cost for the overall sample was $6243 per patient. This cost was significantly higher among patients who underwent CABG ($7234 per patient) than PCI ($5252 per patient). Direct costs accounted for 90%, and indirect costs accounted for 10% of the total costs. And the cost-effectiveness threshold was $14375. The Incremental Cost-Effectiveness Rate (ICER) in reducing mortality rate and increasing Quality of Life (QoL) was $-942.7 and $106050, respectively.
Conclusion: The present study found which intervention (PCI and CABG) had better cost-effectiveness in CAD patients. PCI intervention is more cost-effective than CABG in reducing mortality rate and increasing quality of life. This study tries to resolve the previous controversies regarding the most appropriate treatment for patients with coronary artery disease. It can have significant policy and clinical implications for health policymakers, cardiologists, and health managers.
Keywords: Coronary artery disease, Coronary artery bypass, Percutaneous coronary intervention, Cost-Effectiveness analysis, Cost-Benefit analysis
Type of Study: Research |
Subject:
cardiovascular diseases
Received: 2021/07/3 | Accepted: 2021/08/30 | Published: 2021/03/30
Received: 2021/07/3 | Accepted: 2021/08/30 | Published: 2021/03/30
References
1. [1] World Health Organization (WHO). The global health observatory [Internet]. 2018 [Updated 2018]. Available from: https://www.who.int/data/gho
2. [2] Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, et al. European cardiovascular disease statistics 2017. Brussels: European Heart Network; 2017. Available from: https://www.ehnheart.org/images/CVD-statisticsreport-August-2017.pdf
3. [3] Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1736-88. [DOI:10.1016/S0140-6736(18)32203-7] [DOI:10.1016/S0140-6736(18)32203-7]
4. [4] Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive summary: Heart disease and stroke statistics-2015 update: A report from the American Heart Association. Circulation. 2015; 131(4):434-41. [DOI:10.1161/CIR.0000000000000157] [PMID] [DOI:10.1161/CIR.0000000000000157]
5. [5] Chatterjee A, Roy UK. Non-invasive cardiovascular monitoring. J Environ Sci Comput Sci Eng Technol. 2018; 7(1):033-47 [DOI:10.24214/jecet.b.7.1.03347] [DOI:10.24214/jecet.b.7.1.03347]
6. [6] Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, Brooks MM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: A collaborative analysis of individual patient data from ten randomised trials. Lancet. 2009; 373(9670):1190-7. [DOI:10.1016/S0140-6736(09)60552-3] [DOI:10.1016/S0140-6736(09)60552-3]
7. [7] Allender S, Scarborough P, Peto V, Rayner M. European cardiovascular disease statistics 2012 [Internet]. 2014 [Updated 2012 September 29]. Available from: https://ehnheart.org/projects/euroheart-ii/euroheart-ii-publications/673:european-cardiovascular- disease-statistics-2012.html
8. [8] Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics-2014 update: A report from the American Heart Association. Circulation. 2013; 129(3):e28-292. [DOI:10.1161/01.cir.0000441139.02102.80] [DOI:10.1161/01.cir.0000441139.02102.80]
9. [9] Turpie AGG. Burden of disease: Medical and economic impact of acute coronary syndromes. Am J Manag Care. 2006; 12(16 Suppl):S430-4. [PMID]
10. [10] Gholami SS, Ebadi Fard Azar F, Rezapour A, Tajdini M. Costeffectiveness of coronary artery bypass graft and percutaneous coronary intervention compared to medical therapy in patients with coronary artery disease: A systematic review. Heart Fail Rev. 2019; 24(6):967-75. [DOI:10.1007/s10741-019-09811-3] [PMID] [DOI:10.1007/s10741-019-09811-3]
11. [11] Etemad LR, McCollam PL. Total first-year costs of acute coronary syndrome in a managed care setting. J Manag Care Pharm. 2005; 11(4):300-6. [DOI:10.18553/jmcp.2005.11.4.300] [PMID] [DOI:10.18553/jmcp.2005.11.4.300]
12. [12] McCollam P, Etemad L. Cost of care for new-onset acute coronary syndrome patients who undergo coronary revascularization. J Invasive Cardiol. 2005; 17(6):307-11. [PMID]
13. [13] Menzin J, Wygant G, Hauch O, Jackel J, Friedman M. Oneyear costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database. Curr Med Res Opin. 2008; 24(2):461-8. [DOI:10.1185/030079908X261096] [PMID] [DOI:10.1185/030079908X261096]
14. [14] Hodgson TA, Meiners MR. Cost-of-illness methodology: A guide to current practices and procedures. Milbank Mem Fund Q Health Soc. 1982; 60(3):429-62. [DOI:10.2307/3349801] [PMID] [DOI:10.2307/3349801]
15. [15] Bastida JL, Aguilar PS, González BD. The economic costs of traffic accidents in Spain. J Trauma. 2004; 56(4):883-9. [DOI:10.1097/01.TA.0000069207.43004.A5] [PMID] [DOI:10.1097/01.TA.0000069207.43004.A5]
16. [16] Lopez-Bastida J, Boronat M, Moreno JO, Schurer W. Costs, outcomes and challenges for diabetes care in Spain. Global Health. 2013; 9:17. [DOI:10.1186/1744-8603-9-17] [PMID] [PMCID] [DOI:10.1186/1744-8603-9-17]
17. [17] Rabin R, de Charro F. EQ-SD: A measure of health status from the EuroQol Group. Ann Med. 2001; 33(5):337-43. [DOI:10.3109/07853890109002087] [PMID] [DOI:10.3109/07853890109002087]
18. [18] Ebadi Fard Azar, Solhi M, Chabaksvar F. Investigation of the quality of life of patients with hypertension in health centers. J Educ Health Promot. 2020; 9:185. [DOI:10.4103/jehp.jehp_741_19] [PMID] [PMCID] [DOI:10.4103/jehp.jehp_741_19]
19. [19] Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost-effectiveness of interventions: Alternative approaches. Bull World Health Organ. 2015; 93(2):118-24. [DOI:10.2471/BLT.14.138206] [PMID] [PMCID] [DOI:10.2471/BLT.14.138206]
20. [20] Gonçalves Brandão SM, Rezende PC, Brunner-La Rocca HP, Ju YT, de Lima ACP, Takiuti ME, et al. Comparative cost-effectiveness of surgery, angioplasty, or medical therapy in patients with multivessel coronary artery disease: MASS II trial. Cost Eff Resour Alloc. 2018; 16:55. [DOI:10.1186/s12962-018-0158-z] [PMID] [PMCID] [DOI:10.1186/s12962-018-0158-z]
21. [21] Hueb W, Soares PR, Gersh BJ, César LAM, Luz PL, Puig LB, et al. The medicine, angioplasty, or surgery study (MASS-II): A randomized, controlled clinical trial of three therapeutic strategies for multivessel coronary artery disease: one-year results. Cost Eff Resour Alloc. 2018; 16:55. [DOI:10.1016/j.jacc.2003.08.065] [PMID] [DOI:10.1016/j.jacc.2003.08.065]
22. [22] Stenvall H, Tierala I, Räsänen P, Laine M, Sintonen H, Roine RP. Long-term clinical outcomes, health-related quality of life, and costs in different treatment modalities of stable coronary artery disease. Eur Heart J Qual Care Clin Outcomes. 2017; 3(1):74- 82. [DOI:10.1093/ehjqcco/qcw024] [PMID] [DOI:10.1093/ehjqcco/qcw024]
23. [23] Favarato ME, Hueb W, Boden WE, Lopes N, da Rocha Nogueira CRS, Takiuti M, et al. Quality of life in patients with symptomatic multivessel coronary artery disease: A comparative post hoc analyses of medical, angioplasty or surgical strategies-MASS II trial. Int J Cardiol. 2007; 116(3):364-70. [DOI:10.1016/j.ijcard.2006.06.001] [PMID] [DOI:10.1016/j.ijcard.2006.06.001]
24. [24] Maniadakis N, Kourlaba G, Cokkinos DV, Angeli A, Kyriopoulos J. The economic burden of atherothrombosis in Greece: Results from the THESIS study. Eur J Health Econ. 2013; 14(4):655-65. [DOI:10.1007/s10198-012-0412-9] [PMID] [DOI:10.1007/s10198-012-0412-9]
25. [25] Leal J, Luengo-Fernández R, Gray A, Petersen S, Rayner M. Economic burden of cardiovascular diseases in the enlarged European :union:. Eur Heart J. 2006; 27(13):1610-9. [DOI:10.1093/eurheartj/ehi733] [PMID] [DOI:10.1093/eurheartj/ehi733]
26. [26] Luengo-Fernandez R, Leal J, Gray A, Petersen S, Rayner M. Cost of cardiovascular diseases in the United Kingdom. Heart. 2006; 92(10):1384-9. [DOI:10.1136/hrt.2005.072173] [PMID] [PMCID] [DOI:10.1136/hrt.2005.072173]
27. [27] Chang HS, Kim HJ, Nam CM, Lim SJ, Jang YH, Kim S, et al. The socioeconomic burden of coronary heart disease in Korea. J Prev Med Public Health. 2012; 45(5):291-300. [DOI:10.3961/jpmph.2012.45.5.291] [PMID] [PMCID] [DOI:10.3961/jpmph.2012.45.5.291]
28. [28] Vieira RDO, Hueb W, Hlatky M, Favarato D, Rezende PC, Garzillo CL, et al. Cost-effectiveness analysis for surgical, angioplasty, or medical therapeutics for coronary artery disease: 5-year follow-up of medicine, angioplasty, or surgery study (MASS) II trial. Circulation. 2012; 126(11 Suppl 1):S145-50. [DOI:10.1161/CIRCULATIONAHA.111.084442] [PMID] [DOI:10.1161/CIRCULATIONAHA.111.084442]
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