Document Detail


Cost-effectiveness of percutaneous coronary intervention with drug eluting stents versus bypass surgery for patients with diabetes mellitus and multivessel coronary artery disease: results from the FREEDOM trial.
MedLine Citation:
PMID:  23277307     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Studies from the balloon angioplasty and bare metal stent eras have demonstrated that coronary artery bypass grafting (CABG) is cost-effective compared with percutaneous coronary intervention (PCI) for patients undergoing multivessel coronary revascularization-particularly among patients with complex coronary artery disease or diabetes mellitus. Whether these results apply in the drug-eluting stent (DES) era is unknown.
METHODS AND RESULTS: Between 2005 and 2010, 1900 patients with diabetes mellitus and multivessel coronary artery disease 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 5 dimension 3 level questionnaire. 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 $8622 higher per patient. 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 $3641 higher per patient 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 mellitus and multivessel coronary artery disease.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinical-trials.gov. Unique 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;
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2012-12-31
Journal Detail:
Title:  Circulation     Volume:  127     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-22     Completed Date:  2013-04-18     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  820-31     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00086450
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MeSH Terms
Descriptor/Qualifier:
Aged
Ambulatory Care / economics,  utilization
Angioplasty, Balloon, Coronary / economics*,  mortality
Coronary Artery Bypass / economics*,  mortality
Coronary Artery Disease / economics*,  mortality,  surgery,  therapy
Cost-Benefit Analysis
Diabetes Mellitus, Type 1 / economics,  mortality
Diabetes Mellitus, Type 2 / economics,  mortality
Diabetic Angiopathies / economics*,  mortality,  surgery,  therapy
Drug-Eluting Stents / economics*,  statistics & numerical data
Female
Follow-Up Studies
Hospital Costs / statistics & numerical data
Humans
Male
Middle Aged
Quality of Life
Quality-Adjusted Life Years
Grant Support
ID/Acronym/Agency:
U01 HL071988/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Circulation. 2013 Feb 19;127(7):764-5   [PMID:  23429894 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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