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CABG linked to better outcomes than PCI, but at higher price
Patients who underwent CABG had improved outcomes at 4 years but at a higher overall cost compared with PCI, according to results of a cost-effectiveness analysis of the ASCERT study.
Data from the ASCERT study were previously reported. The large, observational study compared the long-term effectiveness of CABG vs. PCI for the treatment of CAD and results showed a long-term survival advantage for older patients who underwent CABG.
The cost-effectiveness analysis used data from the Society of Thoracic Surgeons and American College of Cardiology Foundation databases, which were linked to CMS claims data, and included 86,244 patients who underwent CABG and 103,549 who underwent PCI for stable ischemic heart disease. All patients were older than 65 years and had two- or three-vessel CAD.
Researchers assessed costs for the index and observation periods (2004-2008) using diagnosis-related group Medicare reimbursement rates. Costs after the observation period were estimated from average Medicare participant per capita expenditure, according to the abstract.
Patients who underwent CABG gained an adjusted average of 0.2525 life-years during the observation period and 0.3801 life-years during a lifetime relative to PCI, according to the results.
Compared with PCI, CABG yielded higher adjusted costs for the index hospitalization ($10,670), study period ($8,145) and lifetime ($11,575).
The researchers calculated that the lifetime incremental cost-effectiveness ratio of CABG vs. PCI was $30,454 quality-adjusted life-years (QALY) gained.
“The present economic analysis shows CABG is more expensive than PCI is, almost entirely due to the initial procedural costs,” the researchers wrote. “It is reasonable to conclude that, after the study period, resource use and costs would largely track in parallel.
“Under the assumption that our analysis has fully recounted for both measured and unmeasured confounding, in patients with stable ischemic heart disease, CABG will often be considered cost effective at thresholds of $30,000 or $50,000/QALY,” they concluded.
Disclosure: The analysis was supported by a grant from the NHLBI and by an Institutional Development Award from the National Institute of General Medicine Sciences of the NIH. One researcher reports financial relationships with Boston Scientific, CeloNova, Daiichi Sankyo/Eli Lilly, the Mayo Foundation and The Medicines Company. The other researchers report no relevant financial disclosures.