| Medical care costs and quality of life after randomization to coronary angioplasty or coronary bypass surgery. Bypass Angioplasty Revascularization Investigation (BARI) Investigators. | |
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MedLine Citation:
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PMID: 8988886 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Randomized trials comparing coronary angioplasty with bypass surgery in patients with multivessel coronary disease have shown no significant differences in overall rates of death and myocardial infarction. We compared quality of life, employment, and medical care costs during five years of follow-up among patients treated with angioplasty or bypass surgery. METHODS: A total of 934 of the 1829 patients enrolled in the randomized Bypass Angioplasty Revascularization Investigation participated in this study. Detailed data on quality of life were collected annually, and economic data were collected quarterly. RESULTS: During the first three years of follow-up, functional-status scores on the Duke Activity Status Index, which measures the ability to perform common activities of daily living, improved more in patients assigned to surgery than in those assigned to angioplasty (P<0.05). Other measures of quality of life improved equally in both groups throughout the follow-up period. Patients in the angioplasty group returned to work five weeks sooner than did patients in the surgery group (P<0.001). The initial mean cost of angioplasty was 65 percent that of surgery ($21,113 vs. $32,347, P<0.001), but after five years the total medical cost of angioplasty was 95 percent that of surgery ($56,225 vs. $58,889), a difference of $2,664 (P = 0.047). The five-year cost of angioplasty was significantly lower than that of surgery among patients with two-vessel disease ($52,930 vs. $58,498, P<0.05), but not among patients with three-vessel disease ($60,918 vs. $59,430). After five years of follow-up, surgery had an overall cost-effectiveness ratio of $26,117 per year of life added, but unacceptable ratios of $100,000 or more per year of life added could not be excluded (P=0.13). Surgery appeared particularly cost effective in treating diabetic patients because of their significantly improved survival. CONCLUSIONS: In patients with multivessel coronary disease, coronary-artery bypass surgery is associated with a better quality of life for three years than coronary angioplasty, after the initial morbidity caused by the procedure. Coronary angioplasty has a lower five-year cost than bypass surgery only in patients with two-vessel coronary disease. |
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Authors:
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M A Hlatky; W J Rogers; I Johnstone; D Boothroyd; M M Brooks; B Pitt; G Reeder; T Ryan; H Smith; P Whitlow; R Wiens; D B Mark |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: The New England journal of medicine Volume: 336 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1997 Jan |
Date Detail:
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Created Date: 1997-01-13 Completed Date: 1997-01-13 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 92-9 Citation Subset: AIM; IM |
Affiliation:
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Stanford University School of Medicine, CA 94305-5092, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary
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economics* Coronary Artery Bypass / economics* Coronary Disease / complications, economics, surgery, therapy* Cost-Benefit Analysis Diabetes Complications Employment / statistics & numerical data Female Follow-Up Studies Health Care Costs* Humans Life Expectancy Male Middle Aged Outcome Assessment (Health Care) Quality of Life* |
| Grant Support | |
ID/Acronym/Agency:
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HL38610/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 1997 Jun 19;336(25):1840-1
[PMID:
9190503
]
ACP J Club. 1997 Jul-Aug;127(1):25 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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