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项昂贵的技术，也是最 在美国经常进行，经皮穿刺术约428,000例 腔内冠状动脉成形术(PTCA)和501,000例冠状动脉 每年进行动脉搭桥术(CABG)。估计的医疗成本 与之相关的血管重建每年从120亿美元到200亿美元不等，L。 退伍军人事务部通过其合作研究计划 进行了随机对照试验(极重度心绞痛 手术死亡率评估[AWE]试验)比较PTCA和CABG在 药物难治性高危心肌的急诊血运重建 缺血症患者。这些有重大并发症高危风险的患者 或手术死亡在很大程度上被排除在其他随机分组之外 对照试验。试验结果表明，冠脉搭桥术和 PTCA的长期存活率相似，但对血运重建的需求更高 在PTCA组。我们相信，阐明医疗保健的使用模式和 这两种治疗策略在该患者群体中的护理成本 将增加医生和患者可用的有用信息 决定使用哪种治疗方法。接受单次PTCA手术的患者 预计需要的资源更少，成本也比患者低 冠脉搭桥术重建血运。但是，要比较总资源利用率和 除了PTCA和CABG的费用外，后续护理的费用也必须包括在 确定PTCA后续成本是否抵消了较低的初始PTCA成本。 据推测，需要更多后续手术的患者的情况会更糟。 与没有后续程序、持有其他因素的同等患者相比 常量。为决策提供有用的信息 为这些患者采取适当的手术策略，无论是成本还是 有效性(以存活率衡量)需要进行比较。我们的特定 研究目标是：1)比较初始血管重建术的成本 心肌缺血患者随机分为经皮冠状动脉腔内成形术和冠状动脉旁路移植术 比较随机化患者的随诊护理利用率和费用 对PTCA和CABG；3)比较患者的总直接医疗费用 从社会(包括VA)的角度随机选择PTCA和CABG 和非VA成本)，并从VA的角度；以及4)确定 PTCA与CABG在这些有效患者中的成本-效果 以存活年数来衡量。

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.