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Coronary artery disease
Original research article
Five-year costs from a randomised comparison of bilateral and single internal thoracic artery grafts
  1. Matthew Little1,
  2. Alastair Gray2,
  3. Doug Altman3,
  4. Umberto Benedetto4,
  5. Marcus Flather5,6,
  6. Stephen Gerry7,
  7. Belinda Lees8,
  8. Jacqueline Murphy2,
  9. Helen Campbell2,
  10. David Taggart8
  1. 1 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2 Nuffield Department of Population Health, University of Oxford Health Economics Research Centre, Oxford, UK
  3. 3 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
  4. 4 University of Bristol School of Clinical Science, Bristol, Bristol, UK
  5. 5 University of East Anglia Faculty of Medicine and Health Sciences, Norwich, Norfolk, UK
  6. 6 Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
  7. 7 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, Oxford, UK
  8. 8 Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, Oxfordshire, UK
  1. Correspondence to Professor Alastair Gray; alastair.gray{at}dph.ox.ac.uk

Abstract

Background The use of bilateral internal thoracic arteries (BITA) for coronary artery bypass grafting (CABG) may improve survival compared with CABG using single internal thoracic arteries (SITA). We assessed the long-term costs of BITA compared with SITA.

Methods Between June 2004 and December 2007, 3102 patients from 28 hospitals in seven countries were randomised to CABG surgery using BITA (n=1548) or SITA (n=1554). Detailed resource use data were collected from the initial hospital episode and annually up to 5 years. The associated costs of this resource use were assessed from a UK perspective with 5 year totals calculated for each trial arm and pre-selected patient subgroups.

Results Total costs increased by approximately £1000 annually in each arm, with no significant annual difference between trial arms. Cumulative costs per patient at 5-year follow-up remained significantly higher in the BITA group (£18 629) compared with the SITA group (£17 480; mean cost difference £1149, 95% CI £330 to £1968, p=0.006) due to the higher costs of the initial procedure. There were no significant differences between the trial arms in the cost associated with healthcare contacts, medication use or serious adverse events.

Conclusions Higher index costs for BITA were still present at 5-year follow-up mainly driven by the higher initial cost with no subsequent difference emerging between 1 year and 5 years of follow-up. The overall cost-effectiveness of the two procedures, to be assessed at the primary endpoint of the 10-year follow-up, will depend on composite differences in costs and quality-adjusted survival.

Trial registration number ISRCTN46552265

  • health care economics
  • coronary artery disease
  • coronary artery disease surgery

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/heartjnl-2018-313932

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    Footnotes

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

    • Funding This work was supported by the British Heart Foundation (SP/03/001), the UK Medical Research Council (G0200390), and the National Institute of Health Research Efficacy and Mechanism Evaluation Programme (09/800/29).

    • Competing interests None declared.

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