CABG continues to be more costly than PCI but with better outcomes

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 - healthcare cost

A U.S. study supports earlier findings that suggest that although CABG is more costly than PCI, patients can expect to live longer with the procedure. This was published in the Jan. 6 issue of the Journal of the American College of Cardiology.

The study was a secondary analysis of ASCERT (American College of Cardiology Foundation – the Society of Thoracic Surgeons Collaboration on Comparative Effectiveness of Revascularization Strategies) data. ASCERT researchers derived their data from  the American College of Cardiology’s National Cardiovascular Data Registry and the Society of Thoracic Surgeons Adult Cardiac Surgery Database, which were then linked to Medicare data.

The observational period lasted between 2004 and 2008. Lead author Zugui Zhang, PhD, of the Value Institute in Newark, Del., and colleagues used Medicare pay tables to calculate cost.

They noted adjusted costs for older patients with two- or three-vessel artery disease were higher for CABG by $10,670 for the index hospitalization, $8,145 for the four-year study period and $11,575 estimated over the lifetime. However, CABG gave patients an average 0.38 life-years more over their lifetime compared with PCI.

Zhang et al determined that the lifetime incremental cost-effectiveness ratio was $30,454/quality-adjusted life-years gained for CABG compared with PCI. They also reported that confounders could significantly shift the cost-effectiveness of the strategy up or down.

A similar study from Austria reported in late 2014 that CABG was only cost-effective if the willingness to pay was high. However, Zhang et al concluded that CABG could be considered cost-effective at willingness-to-pay thresholds between $30,000 and $50,000.

Zhang et al implied that CABG is still a “reasonable value by commonly accepted standards,” according to an editorial by John A. Spiritus, MD, MPH, from Saint Luke’s Mid America Heart Institute in Kansas City, Mo.

While there were expressed concerns regarding whether the data fully represented real-world activity, Spiritus wrote, “the ASCERT registry takes an important first step in assessing the comparative effectiveness of alternative revascularization techniques, but it also highlights important gaps in existing data and the challenge of assessing therapeutic effectiveness from observational data.”

Spiritus suggested that registries take the opportunity to expand to include patient-reported health status data to improve the evidence base on quality outcomes.