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One year comparison of costs of coronary surgery versus percutaneous coronary intervention in the stent or surgery trial.
Heart 2004; 90(7):782-8H

Abstract

OBJECTIVES

To compare initial and one year costs of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in the stent or surgery trial.

DESIGN

Prospective, unblinded, randomised trial.

SETTING

Multicentre study.

PATIENTS

988 patients with multivessel disease.

INTERVENTIONS

CABG and stent assisted PCI.

MAIN OUTCOME MEASURES

Initial hospitalisation and one year follow up costs.

RESULTS

At one year mortality was 2.5% in the PCI arm and 0.8% in the CABG arm (p = 0.05). There was no difference in the composite of death or Q wave myocardial infarction (6.9% for PCI v 8.1% for CABG, p = 0.49). There were more repeat revascularisations with PCI (17.2% v 4.2% for CABG). There was no significant difference in utility between arms at six months or at one year. Quality adjusted life years were similar 0.6938 for PCI v 0.6954 for PCI, Delta = 0.00154, 95% confidence interval (CI) -0.0242 to 0.0273). Initial length of stay was longer with CABG (12.2 v 5.4 days with PCI, p < 0.0001) and initial hospitalisation costs were higher (7321 pounds sterling v 3884 pounds sterling for PCI, Delta = 3437 pounds sterling, 95% CI 3040 pounds sterling to 3848 pounds sterling). At one year the cost difference narrowed but costs remained higher for CABG (8905 pounds sterling v 6296 pounds sterling for PCI, Delta = 2609 pounds sterling, 95% CI 1769 pounds sterling to 3314 pounds sterling).

CONCLUSIONS

Over one year, CABG was more expensive and offered greater survival than PCI but little added benefit in terms of quality adjusted life years. The additional cost of CABG can be justified only if it offers continuing benefit at no further increase in cost relative to PCI over several years.

Authors+Show Affiliations

The Emory Centre for Outcomes Research, Department of Medicine, Emory University, 1256 Briarcliff Road, Suite 1 North, Atlanta, Georgia 30306, USA. wweintr@emory.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15201249

Citation

Weintraub, W S., et al. "One Year Comparison of Costs of Coronary Surgery Versus Percutaneous Coronary Intervention in the Stent or Surgery Trial." Heart (British Cardiac Society), vol. 90, no. 7, 2004, pp. 782-8.
Weintraub WS, Mahoney EM, Zhang Z, et al. One year comparison of costs of coronary surgery versus percutaneous coronary intervention in the stent or surgery trial. Heart. 2004;90(7):782-8.
Weintraub, W. S., Mahoney, E. M., Zhang, Z., Chu, H., Hutton, J., Buxton, M., ... De Cock, E. (2004). One year comparison of costs of coronary surgery versus percutaneous coronary intervention in the stent or surgery trial. Heart (British Cardiac Society), 90(7), pp. 782-8.
Weintraub WS, et al. One Year Comparison of Costs of Coronary Surgery Versus Percutaneous Coronary Intervention in the Stent or Surgery Trial. Heart. 2004;90(7):782-8. PubMed PMID: 15201249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One year comparison of costs of coronary surgery versus percutaneous coronary intervention in the stent or surgery trial. AU - Weintraub,W S, AU - Mahoney,E M, AU - Zhang,Z, AU - Chu,H, AU - Hutton,J, AU - Buxton,M, AU - Booth,J, AU - Nugara,F, AU - Stables,R H, AU - Dooley,P, AU - Collinson,J, AU - Stuteville,M, AU - Delahunty,N, AU - Wright,A, AU - Flather,M D, AU - De Cock,E, PY - 2004/6/18/pubmed PY - 2004/7/21/medline PY - 2004/6/18/entrez SP - 782 EP - 8 JF - Heart (British Cardiac Society) JO - Heart VL - 90 IS - 7 N2 - OBJECTIVES: To compare initial and one year costs of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in the stent or surgery trial. DESIGN: Prospective, unblinded, randomised trial. SETTING: Multicentre study. PATIENTS: 988 patients with multivessel disease. INTERVENTIONS: CABG and stent assisted PCI. MAIN OUTCOME MEASURES: Initial hospitalisation and one year follow up costs. RESULTS: At one year mortality was 2.5% in the PCI arm and 0.8% in the CABG arm (p = 0.05). There was no difference in the composite of death or Q wave myocardial infarction (6.9% for PCI v 8.1% for CABG, p = 0.49). There were more repeat revascularisations with PCI (17.2% v 4.2% for CABG). There was no significant difference in utility between arms at six months or at one year. Quality adjusted life years were similar 0.6938 for PCI v 0.6954 for PCI, Delta = 0.00154, 95% confidence interval (CI) -0.0242 to 0.0273). Initial length of stay was longer with CABG (12.2 v 5.4 days with PCI, p < 0.0001) and initial hospitalisation costs were higher (7321 pounds sterling v 3884 pounds sterling for PCI, Delta = 3437 pounds sterling, 95% CI 3040 pounds sterling to 3848 pounds sterling). At one year the cost difference narrowed but costs remained higher for CABG (8905 pounds sterling v 6296 pounds sterling for PCI, Delta = 2609 pounds sterling, 95% CI 1769 pounds sterling to 3314 pounds sterling). CONCLUSIONS: Over one year, CABG was more expensive and offered greater survival than PCI but little added benefit in terms of quality adjusted life years. The additional cost of CABG can be justified only if it offers continuing benefit at no further increase in cost relative to PCI over several years. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/15201249/One_year_comparison_of_costs_of_coronary_surgery_versus_percutaneous_coronary_intervention_in_the_stent_or_surgery_trial_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&amp;pmid=15201249 DB - PRIME DP - Unbound Medicine ER -