Comparative cost-effectiveness of surgery, angioplasty, or medical therapy in patients with multivessel coronary artery disease: MASS II trial

• Published in: Cost effectiveness and resource allocation 2018-11, Vol.16 (1), p.55-55, Article 55
• Main Authors: Brandão, Sara Michelly Gonçalves, Rezende, Paulo Cury, Rocca, Hans-Peter Brunner-La, Ju, Yang Ting, de Lima, Antonio Carlos Pedroso, Takiuti, Myrthes Emy, Hueb, Whady, Bocchi, Edimar Alcides
• Format: Article
• Language: English
• Subjects: American dollar; Angina pectoris; Angioplasty; Bare metal stent; Bootstrap method; Cardiovascular disease; Clinical trials; Coronary bypass surgery; Coronary vessels; Cost analysis; Cost–benefit analysis; Diabetes; GDP; Gross Domestic Product; Health care expenditures; Heart attacks; Heart surgery; Hospitalization; Intervention; Medical treatment; Milk, Harvey; Patients; Per capita; Percutaneous coronary intervention; Public health; Quality of life; Review; Sensitivity analysis; Stents; Values; Vein & artery diseases
• ISSN: 1478-7547; 1478-7547
• DOI: 10.1186/s12962-018-0158-z

The costs for treating coronary artery disease (CAD) are high worldwide. We performed a prespecified analyses of cost-effectiveness of three therapeutic strategies for multivessel CAD. From May 1995 to May 2000, a total of 611 patients were randomly assigned to coronary artery bypass graft (CABG), n = 203; percutaneous coronary intervention (PCI), n = 205; or medical treatment (MT), n = 203. This cost analysis study was based on the perspective of the Public Health Care System. Initial procedural and follow-up costs for medications, cardiology examinations, and hospitalizations for complications were calculated after randomization. Life-years and quality-adjusted life years (QALYs) were used as effectiveness measures. Incremental cost-effectiveness ratios (ICER) were obtained by using nonparametric bootstrapping methods with 5000 resamples. Initial procedural costs were lower for MT. However, the subsequent 5-year cumulative costs were lower for CABG. Compared with baseline, the three treatment options produced significant improvements in QALYs. After 5 years, PCI and CABG had better QALYs results compared with MT. The ICER results favored CABG and PCI, and favored PCI over CABG in 61% of the drawings. On the other hand, sensitivity analysis showed MT as the preferred therapy compared with CABG and PCI, in the analysis considering higher costs. At 5-year follow-up, the three treatment options yielded improvements in quality of life, with comparable and acceptable costs. However, despite higher initial costs, the comparison of cost-effectiveness after 5 years of follow-up among the three treatments showed both interventions (CABG and PCI) to be cost-effective strategies compared with MT. ISRCTN, ISRCTN66068876, Registered 06/10/1994, http://www.controlled-trials.com/ISRCTN66068876.