Document Detail


Medical costs and quality of life 10 to 12 years after randomization to angioplasty or bypass surgery for multivessel coronary artery disease.
MedLine Citation:
PMID:  15451795     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Coronary bypass surgery (CABG) and angioplasty (PTCA) have been compared in several randomized trials, but data about long-term economic and quality-of-life outcomes are limited. METHODS AND RESULTS: Cost and quality-of-life data were collected prospectively from 934 patients who were randomized in the Bypass Angioplasty Revascularization Investigation (BARI) and followed up for 10 to 12 years. CABG had 53% higher costs initially, but the gap closed to <5% during the first 2 years; after 12 years, the mean cumulative cost of CABG patients was 123,000 dollars versus 120,750 dollars for PTCA, yielding a cost-effectiveness ratio of 14,300 dollars/life-year added. CABG patients experienced significantly greater improvement in their physical functioning for the first 3 years but not in later follow-up. Recurrent angina substantially reduced all quality-of-life measures throughout follow-up. Cumulative costs were significantly higher among patients with diabetes, heart failure, and comorbid conditions and among women; costs also were increased by angina, by the number of revascularization procedures, and among patients who died. CONCLUSIONS: Early differences between CABG and PTCA in costs and quality of life were no longer significant at 10 to 12 years of follow-up. CABG was cost-effective as compared with PTCA for multivessel disease.
Authors:
Mark A Hlatky; Derek B Boothroyd; Kathryn A Melsop; Maria M Brooks; Daniel B Mark; Bertram Pitt; Guy S Reeder; William J Rogers; Thomas J Ryan; Patrick L Whitlow; Robert D Wiens
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2004-09-27
Journal Detail:
Title:  Circulation     Volume:  110     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-06     Completed Date:  2005-05-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1960-6     Citation Subset:  AIM; IM    
Affiliation:
Stanford University School of Medicine, HRP Redwood Building, Room 150, Stanford, CA 94305-5405, USA. hlatky@stanford.edu.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina Pectoris / epidemiology
Angioplasty, Transluminal, Percutaneous Coronary / economics,  psychology,  statistics & numerical data*
Comorbidity
Coronary Artery Bypass / economics,  psychology,  statistics & numerical data*
Coronary Disease / economics,  psychology,  surgery,  therapy*
Coronary Restenosis / epidemiology
Cost-Benefit Analysis
Disease Progression
Employment / statistics & numerical data
Female
Follow-Up Studies
Graft Survival
Health Care Costs*
Humans
Male
Middle Aged
Prospective Studies
Quality of Life
Randomized Controlled Trials as Topic
Recovery of Function
Survival Analysis
Comments/Corrections
Comment In:
Circulation. 2005 Apr 5;111(13):e176-7; author reply e176-7   [PMID:  15811864 ]

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


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