Cost-effectiveness of coronary artery bypass grafts versus percutaneous coronary intervention for revascularization of high-risk patients.
Cost-effectiveness of coronary artery bypass grafts versus percutaneous coronary intervention for revascularization of high-risk patients.
复制标题
冠状动脉旁路移植术与经皮冠状动脉介入治疗高危患者血运重建的成本效益。
DOI：
10.1161/circulationaha.105.570838
复制
发表时间：
2006
期刊：
影响因子：
37.8
通讯作者：
InvestigatorsofVeteransAffairsCooperativeStudiesProgram#385(AWESOME:AnginaWithExtremelySeriousOp
中科院分区：
文献类型：
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作者：
Stroupe,KevinT;Morrison,DouglassA;Hlatky,MarkA;Barnett,PaulG;Cao,Lishan;Lyttle,Christopher;Hynes,DeniseM;Henderson,WilliamG;InvestigatorsofVeteransAffairsCooperativeStudiesProgram#385(AWESOME:AnginaWithExtremelySeriousOp
背景-退伍军人事务部的一项合作研究将难治性心肌缺血的高危患者随机分为两组，一组接受经皮冠状动脉介入治疗（PCI），另一组接受冠状动脉旁路移植术（CABG）。本研究探讨了这些高危patients.Methods和Results-Of 454例患者在16部退伍军人事务部医疗中心，445可用于经济分析（218 PCI和227冠状动脉旁路移植术患者）PCI与CABG的成本效益。从第三方支付者的角度评估了3年和5年的总成本，并通过生存率来衡量有效性。3年后，PCI患者的平均总成本为63 896美元，CABG患者为84 364美元，差异为20 468美元（95%置信区间[CI]为13 918至27 569美元）。通过bootstrapping估计CI。PCI组3年生存率为0.82，CABG组为0.79（P=0.34）。通过自助法评估成本-效果估计的精度。在92.6%的引导复制中，PCI在3年时成本更低，更有效。5年后，PCI患者的平均总成本为81 790美元，CABG患者为100 522美元，差异为18 732美元（95% CI为9873至27 831美元），而PCI患者的5年生存率为0.75，CABG患者为0.70（P=0.21）。在5年，PCI仍然是成本较低，更有效的引导replications.Conclusions-PCI的89.4%，成本较低，至少有效的医学难治性，高风险患者的紧急血运重建超过5年。
Background—A Department of Veterans Affairs Cooperative Study randomized high-risk patients with medically refractory myocardial ischemia, a group largely excluded from previous trials, to urgent revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The present study examined the cost-effectiveness of PCI versus CABG for these high-risk patients.Methods and Results—Of 454 patients at 16 Department of Veterans Affairs medical centers, 445 were available for the economic analysis (218 PCI and 227 CABG patients). Total costs were assessed at 3 and 5 years from the third-party payer’s perspective, and effectiveness was measured by survival. After 3 years, average total costs were $63 896 for PCI versus $84 364 for CABG patients, a difference of $20 468 (95% confidence interval [CI] $13 918 to $27 569). CIs were estimated by bootstrapping. Survival at 3 years was 0.82 for PCI versus 0.79 for CABG patients (P=0.34). Precision of the cost-effectiveness estimates were assessed by bootstrapping. PCI was less costly and more effective at 3 years in 92.6% of the bootstrap replications. After 5 years, average total costs were $81 790 for PCI versus $100 522 for CABG patients, a difference of $18 732 (95% CI $9873 to $27 831), whereas survival at 5 years was 0.75 for PCI patients versus 0.70 for CABG patients (P=0.21). At 5 years, PCI remained less costly and more effective in 89.4% of the bootstrap replications.Conclusions—PCI was less costly and at least as effective for the urgent revascularization of medically refractory, high-risk patients over 5 years.