Cost-effectiveness of PTCA vs CABG in high-risk patients

描述（由申请人提供）： 冠状动脉血运重建是一种昂贵的技术， 在美国经常进行，约有428，000例经皮 经腔冠状动脉成形术（PTCA）和501，000冠状动脉 动脉旁路移植术（CABG）。估计医疗费用 与血运重建相关的费用每年在120亿美元到200亿美元之间。 退伍军人事务部通过其合作研究计划 进行了一项随机对照试验（极严重心绞痛 手术死亡率评价[AWESOME]试验），以比较PTCA与CABG， 难治性高危心肌梗死患者的紧急血运重建 缺血患者。这些患者有发生严重并发症的高风险， 或手术死亡在很大程度上被其他随机 对照试验。AWESOME试验的结果表明， 经皮冠状动脉成形术有相似的长期生存率，但需要更高的血运重建 在PTCA组。我们认为，阐明医疗保健使用模式和 这两种治疗策略在该患者人群中的护理成本 将为医生和患者提供有用的信息， 决定使用哪种治疗方法。接受单次PTCA手术的患者 预计需要更少的资源和成本低于病人 冠状动脉旁路移植术然而，为了比较总资源利用率和 除了PTCA和CABG的费用外，还必须包括后续护理的费用， 确定PTCA后续费用是否抵消了较低的初始PTCA费用。 据推测，需要更多后续程序的患者的情况会更糟 与没有随访程序的同等患者相比， 常数提供对决策有用的信息， 为这些患者提供适当的手术策略， 有效性（以生存率衡量）需要进行比较。我们的具体 研究目的是：1）比较初始血运重建的成本 随机接受PTCA和CABG的心肌缺血患者之间的手术; 2） 比较随机化患者的随访护理利用率和成本 PTCA和CABG; 3）比较患者的总直接医疗费用 从社会角度（包括VA）随机分配至PTCA和CABG组 （4）从增值税的角度， 在这些有效患者中，PTCA与CABG的成本-效果 以生存年数来衡量。

DESCRIPTION (provided by applicant): Coronary revascularization is an expensive technique and among the most frequently performed in the United States, with about 428,000 percutaneous transluminal coronary angioplasty (PTCA) procedures and 501,000 coronary artery bypass grafts (CABG) performed per year. Estimated healthcare costs associated with-revascularizations range from $12 to $20 billion each year l. The Department of Veterans Affairs through its Cooperative Studies Program conducted a randomized controlled trial (the Angina With Extremely Serious Operative Mortality Evaluation [AWESOME] trial) to compare PTCA to CABG for the urgent revascularization of medically refractory, high-risk myocardial ischemia patients. These patients who are at high risk for major complications or death from surgery have largely been excluded from other randomized controlled trials. The results of the AWESOME trial indicate that CABG and PTCA have similar long-term survival but need for revascularization is higher in the PTCA group. We believe that elucidating the healthcare use patterns and the costs of care of these two treatment strategies in this patient population would add to the useful information available to physicians and patients in deciding which treatment to use. A patient receiving a single PTCA procedure is expected to require fewer resources and to cost less than a patient revascularized by CABG. However, to compare total resource utilization and cost of PTCA and CABG, the costs of follow-up care must also be included to determine whether PTCA follow-up costs offset the lower initial PTCA costs. Presumably, a patient requiring more follow-up procedures would be worse off than an equivalent patient with no follow-up procedures, holding other factors constant. To provide information useful for decision making about the appropriate surgical strategies for these patients, both cost and effectiveness (as measured by survival) need to be compared. Our specific research objectives are: 1) to compare costs of an initial revascularization procedure between myocardial ischemia patients randomized to PTCA and CABG; 2) to compare utilization and costs of follow-up care between patients randomized to PTCA and CABG; 3) to compare total direct healthcare costs of patients randomized to PTCA and CABG from the perspective of society (which includes VA and non-VA costs) and from the perspective of the VA; and 4) to determine the cost-effectiveness of PTCA versus CABG in these patients with effectiveness measured in years of survival.