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(Circulation. 2006;114:1251-1257.)
© 2006 American Heart Association, Inc.

Health Services and Outcomes Research

Cost-Effectiveness of Coronary Artery Bypass Grafts Versus Percutaneous Coronary Intervention for Revascularization of High-Risk Patients

Kevin T. Stroupe, PhD; Douglass A. Morrison, MD, PhD; Mark A. Hlatky, MD; Paul G. Barnett, PhD; Lishan Cao, MS; Christopher Lyttle, MA; Denise M. Hynes, RN, PhD; William G. Henderson, PhD, for the Investigators of Veterans Affairs Cooperative Studies Program #385 (AWESOME: Angina With Extremely Serious Operative Mortality Evaluation)

From the Cooperative Studies Program Coordinating Center (K.T.S.), Hines VA Hospital, Hines, Ill; Midwest Center for Health Services and Policy Research (K.T.S., D.M.H.), Hines VA Hospital, Hines, Ill; Feinberg School of Medicine (K.T.S., L.C., C.L.), Chicago, Ill; VA Information Resource Center (K.T.S., D.M.H.), Hines, Ill; Tucson VA Medical Center (D.A.M.), Tucson, Ariz; University of Arizona (D.A.M.), Tucson, Ariz; Stanford University School of Medicine (M.A.H., P.G.B.), Stanford, Calif; VA Health Economics Resource Center (P.G.B.), Menlo Park, Calif; VA Cooperative Studies Program Coordinating Center (P.G.B.), Palo Alto, Calif; Loyola University Chicago (D.M.H.), Maywood, Ill; and University of Colorado Health Outcomes Program (W.G.H.), Aurora, Col.

Correspondence to Kevin T. Stroupe, PhD, Edward Hines, Jr, VA Hospital, PO Box 5000 (151H), Hines, IL 60141. E-mail Kevin.Stroupe{at}va.gov

Received June 22, 2005; revision received June 23, 2006; accepted June 27, 2006.

Background— A Department of Veterans Affairs Cooperative Study randomized high-risk patients with medically refractory myocardial ischemia, a group largely excluded from previous trials, to urgent revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The present study examined the cost-effectiveness of PCI versus CABG for these high-risk patients.

Methods and Results— Of 454 patients at 16 Department of Veterans Affairs medical centers, 445 were available for the economic analysis (218 PCI and 227 CABG patients). Total costs were assessed at 3 and 5 years from the third-party payer’s perspective, and effectiveness was measured by survival. After 3 years, average total costs were $63 896 for PCI versus $84 364 for CABG patients, a difference of $20 468 (95% confidence interval [CI] $13 918 to $27 569). CIs were estimated by bootstrapping. Survival at 3 years was 0.82 for PCI versus 0.79 for CABG patients (P=0.34). Precision of the cost-effectiveness estimates were assessed by bootstrapping. PCI was less costly and more effective at 3 years in 92.6% of the bootstrap replications. After 5 years, average total costs were $81 790 for PCI versus $100 522 for CABG patients, a difference of $18 732 (95% CI $9873 to $27 831), whereas survival at 5 years was 0.75 for PCI patients versus 0.70 for CABG patients (P=0.21). At 5 years, PCI remained less costly and more effective in 89.4% of the bootstrap replications.

Conclusions— PCI was less costly and at least as effective for the urgent revascularization of medically refractory, high-risk patients over 5 years.

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