| Cost-Effectiveness of Percutaneous Coronary Intervention with Drug Eluting Stents versus Bypass Surgery for Patients with Diabetes and Multivessel Coronary Artery Disease: Results from the FREEDOM Trial. | |
| | |
MedLine Citation:
|
PMID: 23277307 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
BACKGROUND: Studies from the balloon angioplasty and bare metal stent eras have demonstrated that CABG is cost-effective compared with PCI for patients undergoing multivessel coronary revascularization-particularly among patients with complex CAD or diabetes. Whether these results apply in the drug-eluting stent (DES) era is unknown. METHODS AND RESULTS: Between 2005 and 2010, 1900 patients with diabetes and multivessel CAD were randomized to PCI with DES (DES-PCI; n=953) or CABG (n=947). Costs were assessed from the perspective of the U.S. health care system. Health state utilities were assessed using the EuroQOL. A patient-level microsimulation model based on U.S. life-tables and in-trial results was used to estimate lifetime cost-effectiveness. Although initial procedural costs were lower for CABG, total costs for the index hospitalization were $8,622/patient higher. Over the next 5 years, follow-up costs were higher with PCI, owing to more frequent repeat revascularization and higher outpatient medication costs. Nonetheless, cumulative 5-year costs remained $3,641/patient higher with CABG. Although there were only modest gains in survival with CABG during the trial period, when the in-trial results were extended to a lifetime horizon, CABG was projected to be economically attractive relative to DES-PCI, with substantial gains in both life expectancy and quality-adjusted life expectancy and incremental cost-effectiveness ratios <$10,000 per life-year or quality-adjusted life-year gained across a broad range of assumptions regarding the effect of CABG on post-trial survival and costs. CONCLUSIONS: Despite higher initial costs, CABG is a highly cost-effective revascularization strategy compared with DES-PCI for patients with diabetes and multivessel CAD. CLINICAL TRIAL REGISTRATION INFORMATION: http://www.clinical-trials.gov; Identifier: NCT00086450. |
| | |
Authors:
|
Elizabeth A Magnuson; Michael E Farkouh; Valentin Fuster; Kaijun Wang; Katherine Vilain; Haiyan Li; Jaime Appelwick; Victoria Muratov; Lynn A Sleeper; Robin Boineau; Mouin Abdallah; David J Cohen |
Related Documents
:
|
23075857 - Long-term outcome after monosegmental l4/5 stabilization for degenerative spondylolisth... 23245187 - Systematic review: do patient expectations influence treatment outcomes in total knee a... 1279967 - A multicenter, randomized, controlled trial to evaluate the effect of prophylactic octr... 15301047 - Etiology and outcome of childhood and adolescent diabetes mellitus in north india. 16799017 - In vivo corneal confocal microscopy comparison of intralase femtosecond laser and mecha... 21349967 - Carotid artery stenting without angioplasty and cerebral protection: a single-center ex... |
Publication Detail:
|
Type: JOURNAL ARTICLE Date: 2012-12-31 |
Journal Detail:
|
Title: Circulation Volume: - ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2012 Dec |
Date Detail:
|
Created Date: 2013-1-1 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0147763 Medline TA: Circulation Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
|
1 Saint Luke's Mid America Heart Institute, Kansas City, MO; |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: A History of Stroke/Transient Ischemic Attack Indicates High Risks of Cardiovascular Event and Hemor...
Next Document: Frequency of Myocardial Infarction and Its Relationship to Angiographic Collateral Flow in Territori...