Document Detail

Cost-effectiveness of distal embolic protection for patients undergoing percutaneous intervention of saphenous vein bypass grafts: results from the SAFER trial.
MedLine Citation:
PMID:  15519010     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The goal of this research was to determine the incremental cost and cost-effectiveness of embolic protection in patients undergoing percutaneous revascularization (PCI) of diseased saphenous vein bypass grafts (SVGs). BACKGROUND: Distal protection using the GuardWire balloon occlusion device has been shown to reduce major ischemic complications in patients undergoing SVG PCI, but the cost-effectiveness of this approach is unknown. METHODS: We prospectively measured medical resource utilization and cost for 801 patients undergoing SVG intervention who were randomized to distal protection using the GuardWire (n = 406) or conventional treatment (n = 395) in the Saphenous Vein Graft Angioplasty Free of Emboli Randomized (SAFER) trial. Long-term survival and cost-effectiveness were projected based on observed 30-day outcomes and a validated survival model for postcoronary artery bypass graft patients. RESULTS: Compared with conventional treatment, distal protection increased initial procedural costs by approximately $1,600 ($6,326 vs. $4,779, p < 0.001). However, by reducing ischemic complications, distal protection reduced mean length of stay by 0.4 days and other hospital costs by nearly $1,000 ($6,846 vs. $7,811, p = 0.018). As a result, overall initial hospital costs were only $582 per patient higher with distal protection. Based on the observed 30-day cost and outcome differences in the trial, the incremental cost-effectiveness ratio for distal protection was $3,718 per year of life saved and remained <$40,000 per year of life saved in 97.3% of bootstrap simulations (95% confidence interval, $0 to $43,079). CONCLUSIONS: For patients undergoing PCI of diseased SVGs, distal protection using the GuardWire system is an attractive use of limited health care resources.
David J Cohen; Sabina A Murphy; Donald S Baim; Tara A Lavelle; Ronna H Berezin; Donald E Cutlip; Kalon K L Ho; Richard E Kuntz;
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  44     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-02     Completed Date:  2005-01-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1801-8     Citation Subset:  AIM; IM    
Harvard Clinical Research Institute, Boston, Massachusetts, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / economics*
Coronary Disease / economics,  therapy
Coronary Restenosis / economics,  mortality,  prevention & control
Cost-Benefit Analysis
Embolism / economics*,  mortality,  prevention & control*
Follow-Up Studies
Hospital Mortality
Middle Aged
Multivariate Analysis
Patient Admission / economics
Postoperative Complications / economics*,  mortality,  prevention & control*
Prospective Studies
Quality-Adjusted Life Years
Saphenous Vein / pathology*,  surgery*
Treatment Outcome
Comment In:
J Am Coll Cardiol. 2004 Nov 2;44(9):1809-11   [PMID:  15519011 ]
J Am Coll Cardiol. 2004 Nov 2;44(9):1812-8   [PMID:  15519012 ]

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