Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Medicine in Ischemic Cardiomyopathy: The STICH Randomized Clinical Trial.
Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Medicine in Ischemic Cardiomyopathy: The STICH Randomized Clinical Trial.
复制标题
DOI：
10.1161/circulationaha.121.056276
复制
发表时间：
2022-03-15
期刊：
影响因子：
37.8
通讯作者：
STICH Investigators
中科院分区：
文献类型：
--
作者：
Chew DS;Cowper PA;Al-Khalidi H;Anstrom KJ;Daniels MR;Davidson-Ray L;Li Y;Michler RE;Panza JA;Piña IL;Rouleau JL;Velazquez EJ;Mark DB;STICH Investigators
The Surgical Treatment for Ischemic Heart Failure Trial (STICH) demonstrated that coronary artery bypass grafting (CABG) reduced all-cause mortality rates out to 10 years compared with medical therapy alone (MED) in patients with ischemic cardiomyopathy and reduced left ventricular function (ejection fraction ≤35%). We examined the economic implications of these results. We used a decision-analytic patient-level simulation model to estimate the lifetime costs and benefits of CABG and MED using patient-level resource use and clinical data collected in the STICH trial. Patient-level costs were calculated by applying externally derived US cost weights to resource use counts during trial follow-up. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio (ICER) assessed from the US healthcare sector perspective. For the CABG arm, we estimated 6.53 quality-adjusted life years (QALYs) (95% confidence internal (CI) 5.70 to 7.53) and a lifetime cost of $140,059 (95% CI $106,401 to $180,992). For the MED arm, the corresponding estimates were 5.52 (95% CI 5.06 to 6.09) QALYs and $74,894 lifetime cost (95% CI $58,372 to $93,541). The ICER for CABG compared to MED was $63,989 per QALY gained. At a societal willingness-to-pay threshold of $100,000 per QALY gained, CABG was found to be economically favorable compared to medical therapy in 87% of microsimulations. In STICH patients with ischemic cardiomyopathy and reduced left ventricular function, CABG was economically attractive relative to medical therapy at current benchmarks for value in the United States. URL: https://www.clinicaltrials.gov/ct2/show/NCT00023595; Unique Identifier: NCT00023595
