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CORONARY BYPASS SURGERY VERSUS PERCUTANEOUS CORONARY INTERVENTION: COST-EFFECTIVENESS IN IRAN: A STUDY IN PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE

Published online by Cambridge University Press:  17 November 2014

Mehdi Javanbakht ,
Razieh Yazdani Bakhsh ,
Atefeh Mashayekhi ,
Hossein Ghaderi  and
Masoumeh Sadeghi
Mehdi Javanbakht
Affiliation:
Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen; Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciencesm.javanbakht@abdn.ac.uk
Razieh Yazdani Bakhsh
Affiliation:
Isfahan University of Medical Sciences
Atefeh Mashayekhi
Affiliation:
Tehran University of Medical Sciences
Hossein Ghaderi
Affiliation:
Health Economics Department, School of Health Management and Information Sciences, Iran University of Medical Sciences
Masoumeh Sadeghi
Affiliation:
Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences
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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.

Keywords

Cost effectiveness analysisPercutaneous coronary interventionCoronary artery bypass graftIranQuality adjusted life years
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 30 , Issue 4 , October 2014 , pp. 366 - 373
Copyright
Copyright © Cambridge University Press 2014 

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