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Original research article
One-year costs of bilateral or single internal mammary grafts in the Arterial Revascularisation Trial
  1. Alastair M Gray1,
  2. Jacqueline Murphy1,
  3. Douglas G Altman2,
  4. Umberto Benedetto3,
  5. Helen Campbell1,
  6. Marcus Flather4,
  7. Stephen Gerry2,
  8. Belinda Lees5,
  9. David P Taggart5
  1. 1 Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Headington, UK
  2. 2 Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK
  3. 3 School of Clinical Sciences, University of Bristol and Bristol Royal Infirmary, Bristol, UK
  4. 4 Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK
  5. 5 Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Professor Alastair M Gray, Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK; alastair.gray{at}


Objective Coronary artery bypass grafting (CABG) using bilateral internal mammary arteries (BIMA) may improve survival over CABG using single internal mammary arteries (SIMA), but may be surgically more complex (and therefore costly) and associated with impaired sternal wound healing. We report, for the first time, a detailed comparison of healthcare resource use and costs over 12 months, as part of the Arterial Revascularisation (ART) Trial.

Methods 3102 patients in 28 hospitals in seven countries were randomised to CABG surgery using BIMA (n=1548) or SIMA (n=1554). Detailed resource use data were collected covering surgery, the initial hospital episode, and for 12 months post randomisation. Using UK unit costs, total costs were calculated and compared between trial arms and for subgroups.

Results Patients randomised to BIMA spent 20 min longer in theatre (95% CI 15 to 25, p<0.001) and also required more treatment for sternal wound problems. Mean (SD) total costs per patient at 12 months were £13 839 (£10 534) for BIMA and £12 717 (£9719) for SIMA (mean cost difference £1122, 95% CI £407 to £1838, p=0.002). No tests for interaction between subgroups and treatment allocation were significant.

Conclusions At 12 months from randomisation, mean costs were approximately 9% higher in BIMA than SIMA patients, primarily due to longer time in theatre and in-hospital stay, and slightly higher costs related to sternal wound problems during follow-up. Follow-up to the primary trial endpoint of 10 years will reveal whether longer-term differences emerge in graft patency or in overall survival.

Trial registration number (ISRCTN46552265).

  • Revascularization
  • Bypass
  • Costs

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  • Contributors AG designed and led the economic analysis. JM and HC conducted the data analysis for this study. DT conceived and leads the ART Trial and is principal investigator. DA and SG provided statistical expertise and analysis. JM and AG drafted the manuscript. DA, UB, HC, MF, SG, BL and DT all contributed to refinement of this study and commented on drafts of the manuscript. All authors approved the final manuscript.

  • Competing interests None declared.

  • Patient consent Every patient was required to provide written informed consent. No identifiable information is presented in this analysis.

  • Ethics approval Local Ethics Committee of each participating hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All requests concerning data from the ART trial should be directed in the first instanced to the Principal Investigator, David Taggart, at Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.