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(Circulation. 2004;110:1960-1966.)
© 2004 American Heart Association, Inc.

Health Services and Outcomes Research

Medical Costs and Quality of Life 10 to 12 Years After Randomization to Angioplasty or Bypass Surgery for Multivessel Coronary Artery Disease

Mark A. Hlatky, MD; Derek B. Boothroyd, PhD; Kathryn A. Melsop, MS; Maria M. Brooks, PhD; Daniel B. Mark, MD, MPH; Bertram Pitt, MD; Guy S. Reeder, MD; William J. Rogers, MD; Thomas J. Ryan, MD; Patrick L. Whitlow, MD; Robert D. Wiens, MD

From the Stanford University School of Medicine, Stanford, Calif (M.A.H., D.B.B., K.A.M.); the University of Pittsburgh, Pa (M.M.B.); Duke University, Durham, NC (D.B.M.); the University of Michigan, Ann Arbor (B.P.); the Mayo Clinic, Rochester, Minn (G.S.R.); the University of Alabama at Birmingham (W.J.R.); the Boston University School of Medicine, Mass (T.J.R.); the Cleveland Clinic, Ohio (P.L.W.); and Saint Louis University, Mo (R.D.W.).

Reprint requests to Mark A. Hlatky, MD, Stanford University School of Medicine, HRP Redwood Building, Room 150, Stanford, CA 94305-5405. E-mail hlatky{at}stanford.edu

Received October 27, 2003; de novo received April 30, 2004; revision received June 29, 2004; accepted June 30, 2004.

Background— Coronary bypass surgery (CABG) and angioplasty (PTCA) have been compared in several randomized trials, but data about long-term economic and quality-of-life outcomes are limited.

Methods and Results— Cost and quality-of-life data were collected prospectively from 934 patients who were randomized in the Bypass Angioplasty Revascularization Investigation (BARI) and followed up for 10 to12 years. CABG had 53% higher costs initially, but the gap closed to <5% during the first 2 years; after 12 years, the mean cumulative cost of CABG patients was $123 000 versus $120 750 for PTCA, yielding a cost-effectiveness ratio of $14 300/life-year added. CABG patients experienced significantly greater improvement in their physical functioning for the first 3 years but not in later follow-up. Recurrent angina substantially reduced all quality-of-life measures throughout follow-up. Cumulative costs were significantly higher among patients with diabetes, heart failure, and comorbid conditions and among women; costs also were increased by angina, by the number of revascularization procedures, and among patients who died.

Conclusion— Early differences between CABG and PTCA in costs and quality of life were no longer significant at 10 to 12 years of follow-up. CABG was cost-effective as compared with PTCA for multivessel disease.

Key Words: cost-benefit analysis • follow-up studies • angioplasty • surgery • coronary disease

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