Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents in patients with multivessel coronary artery disease compared to coronary artery bypass surgery five-years after intervention: Cost-Effectiveness CABG Versus DES-PCI

ObjectivesCost-effectiveness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES), and coronary artery bypass surgery (CABG) was analyzed in patients with multivessel coronary artery disease over a 5-year follow-up.BackgroundDES implantation reducing revascularization rate and associated costs might be attractive for health economics as compared to CABG.MethodsConsecutive patients with multivessel DES-PCI (n=114, 3.31.2 DES/patient) or CABG (n=85, 2.70.9 grafts/patient) were included prospectively. Primary endpoint was cost-benefit of multivessel DES-PCI over CABG, and the incremental cost-effectiveness ratio (ICER) was calculated. Secondary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE), including acute myocardial infarction (AMI), all-cause death, revascularization, and stroke.ResultsDespite multiple uses for DES, in-hospital costs were significantly less for PCI than CABG, with 4551 Euro/patient difference between the groups. At 5-years, the overall costs remained higher for CABG patients (mean difference 5400 Euro between groups). Cost-effectiveness planes including all patients or subgroups of elderly patients, diabetic patients, or Syntax score >32 indicated that CABG is a more effective, more costly treatment mode for multivessel disease. At the 5-year follow-up, a higher incidence of MACCE (37.7% vs. 25.8%; log rank P=0.048) and a trend towards more AMI/death/stroke (25.4% vs. 21.2%, log rank P=0.359) was observed in PCI as compared to CABG. ICER indicated 45615 Euro or 126683 Euro to prevent one MACCE or AMI/death/stroke if CABG is performed.ConclusionsCost-effectiveness analysis of DES-PCI vs. CABG demonstrated that CABG is the most effective, but most costly, treatment for preventing MACCE in patients with multivessel disease. (c) 2014 Wiley Periodicals, Inc.