Coronary Artery Bypass Graft Compared to Percutaneous Coronary Interventions in Patients With Coronary Artery Disease: A Cost-Effectiveness Analysis

Background and Aim: Coronary Artery Diseases (CADs) affect different physical, social, and economic aspects of patients’ lives. The cost-effectiveness analysis is a way to examine both the costs and health outcomes of one or more therapeutic interventions of this disease. In other words, it compares an intervention to another one by estimating how much it costs to gain a unit of a health outcome, for instance, a life-year gained or death prevented. This study aimed to compare Coronary Artery Bypass Graft (CABG) with Percutaneous Coronary Intervention (PCI) in patients with CADs. Materials and Methods: This study is descriptive-analytical. It was conducted on ۶۰۱ patients who underwent CABG (n=۲۸۷) and PCI (n=۳۱۴) in three aspects. The first aspect is to measure the effectiveness of CABG and PCI (cardiac mortality rate and quality of life). The second aspect is to estimate the direct costs (e.g. medical and non-medical costs) and indirect costs (e.g. productivity losses due to morbidity and mortality) based on a societal perspective. The third aspect is the cost-effectiveness analysis. The obtained data were analyzed with Markov cohort simulation using Excel and the TreeAge tool. Uncertainties related to model parameters were evaluated using ۱-way and ۲-way sensitivity analyses. Results: During the follow-up period, ۲% and ۰.۸% of patients died after CABG and PCI intervention, respectively. The Mean±SD EuroQol- ۵ Dimension (EQ-۵D) score after ۱۲ months was ۰.۷۲±۰.۱۵ for the CABG group and ۰.۶۶±۰.۱۹ for the PCI group. All the therapeutic strategies yielded significant improvement in all dimensions during the follow-up. The mean annual total cost for the overall sample was ۶۲۴۳ per patient. This cost was significantly higher among patients who underwent CABG (۷۲۳۴ per patient) than PCI (۵۲۵۲ per patient). Direct costs accounted for ۹۰%, and indirect costs accounted for ۱۰% of the total costs. And the cost-effectiveness threshold was ۱۴۳۷۵. The Incremental Cost-Effectiveness Rate (ICER) in reducing mortality rate and increasing Quality of Life (QoL) was -۹۴۲.۷ and ۱۰۶۰۵۰, respectively. Conclusion: The present study found which intervention (PCI and CABG) had better cost-effectiveness in CAD patients. PCI intervention is more cost-effective than CABG in reducing mortality rate and increasing quality of life. This study tries to resolve the previous controversies regarding the most appropriate treatment for patients with coronary artery disease. It can have significant policy and clinical implications for health policymakers, cardiologists, and health managers.

کلیدواژه ها:

Coronary artery disease ، Coronary artery bypass ، Percutaneous coronary intervention ، Cost-Effectiveness analysis ، Cost-Benefit analysis