Abstract 12022: Cost-Effectiveness Analysis for Surgical, Angioplasty or Medical Therapeutic for Coronary Artery Disease: 5-Year follow-Up of MASS II Trial
Purpose: This investigation compares the economic outcome, in the 5-year follow-up, of the 3 therapeutic strategies for multivessel coronary artery disease (CAD).
Methods: Medicine, Angioplasty, or Surgery Study (MASS) II trial randomized patients with multivessel CAD and normal systolic ventricular function. Patients were submitted to coronary artery bypass graft surgery (CABG, n=203), percutaneous coronary intervention (PCI, n=205) and medical treatment alone (MT, n=203). The composite primary end-point was the necessity of revascularization procedures, acute myocardial infarction, and death. We analyzed the cumulative cost in the 5-year follow-up period. Resource utilization included: initial revascularization procedure after randomization, and subsequent revascularization procedures; subsequent hospitalization for cardiovascular disease; outpatient visits; and cardiovascular tests. Costs were expressed in US dollars. Cumulative costs were compared on the intention-to-treat basis. To analyze the cost-effectiveness, adjustment was made on the cumulative costs for average event-free time,and angina-free proportion.
Results: The average time for first event was 3.79 years for MT, 3.59 years for PCI, and 4.4 years for CABG group (P=0.0026). At the 5-year follow-up, the angina-free proportion was 54.8% for MT, 77.3% for PCI, and 74.2% for CABG group (P<0.001). At the 5-year follow-up, the event-free costs were US$ 7.587,51 for MT; US$ 16.883,59 for PCI; andUS$ 15.642,63 for CABG group. The pair comparison of the event-free costs showed that there was a significant difference favoring MT versus PCI (P<0.001), and versus CABG (P<0.001); there was no difference between CABG and PCI (P=0.08). The event-free plus angina-free costs were US$13.845,82 for MT; US$ 21.841,65 for PCI; US$ 21.081,72 for CABG group. The pair comparison of the event-freeplus angina-free costs showed that there was a significant difference favoring MT versus PCI (P<0.001), and versus CABG (P<0.001); a significant difference favors CABG versus PCI (P=0.013).
Conclusion: In the long-term economic analysis, for the prevention of composite primary end-point and angina, the MT had a better cost-effectiveness than CABG, and this in turn, more than PCI.
- © 2011 by American Heart Association, Inc.