Special articleCost-effectiveness of bypass surgery versus stenting in patients with multivessel coronary artery disease☆
Section snippets
Study design and model
This study is based on data from BARI (22), which involved patients with multivessel disease randomly assigned to either CABG or angioplasty for the treatment of angina. We used decision-analysis software (DATA 4.0; TreeAge, Williamstown, Massachusetts) to model cardiac events from the time of initial revascularization until death. The model estimates the cost to payers for providing revascularization and subsequent medical care, and the quality-adjusted life-years (QALYs) for life with
Model validation
The modeled 4-year costs for balloon angioplasty and CABG corresponded with the costs in SEQOL to within 1.5% 23, 25. The SEQOL time trade-off survey results indicated that over 7.3 years of follow-up, angioplasty patients perceived that 1 year of life equated to 0.848 QALYs, whereas CABG patients experienced slightly better quality of life (0.86 QALYs) (27). The angioplasty model projected an average of 0.84 QALYs per year, compared with 0.86 QALYs per year in the CABG model, which was within
Discussion
Coronary stents were initially approved by the Food and Drug Administration for use in patients with suboptimal angioplasty results. Stent use has reduced both emergency CABG and in-hospital mortality 7, 52, 53, 54. Since 1993, stent use has increased well beyond the provisional indication. In one large study (52), the proportion of provisional stent procedures dropped from 44% to 14% between 1996 and 1998, and primary stent use grew from 44% to 72%.
Because the current study is based on data
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Supported by Grant 15151 from the Robert Wood Johnson Foundation, Princeton, New Jersey, and by Grant HL-58324 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.