Abstract 18630: Cost-effectiveness of Revascularization Strategies: A Preliminary Study from ASCERT

Abstract

Background: Using data from the Society of Thoracic Surgeons (STS) Database and the American College of Cardiology Foundation (ACCF) National Cardiovascular Data Registry (NCDR) in ASCERT, we examined the cost-effectiveness of coronary-artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI).

Methods: The STS Database and ACCF NCDR were linked to the Centers for Medicare and Medicaid Services (CMS) claims data from years 2004 to 2008. Costs were assessed at index, 1 year and 4 years by Diagnosis Related Group for hospitalizations. Effectiveness was measured via mortality rate and converted to life year gained (LYG) from Framingham survival data. Costs and effectiveness were adjusted using propensity scores and inverse probability weighting to reduce treatment selection bias. The incremental cost-effectiveness ratio (ICER) was expressed as cost per LYG.

Results: Among patients (86,244 in CABG group and 103,549 in PCI group) at least 65 years old with two or three vessel coronary artery disease, costs were higher for CABG by $10,951 (95% CI: $10,899 to $11,003) during the index hospitalization and by $9,906 (95% CI: $9,824 to $9,988) at 1 year, compared to PCI. At 4 years, average total costs were $32,428 for CABG versus $24,623 for PCI, a difference of $7,825 (95% CI: $7,693 to $7,927). For life time, average total costs were $88,125 for CABG versus $82,020 for PCI, a difference of $6,105 (95% CI: $5,990 to $6,327); patients undergoing CABG gained an average of 0.1268 life-years relative to PCI; the ICER of CABG, compared to PCI, was $48,135 per LYG, with 15.3%, 40.5%, 78.2%, and 85.7% of bootstrap-derived estimates <$25,000/LYG , <$50,000/LYG , <$75,000/LYG , and <$100,000/LYG, respectively.

Conclusions: In the period of less than 1 year, CABG was more costly and less effective than PCI. However, in the long run, CABG offers lower mortality at higher cost than PCI. Using a common threshold, CABG will often be a cost-effective strategy.