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

高危患者中 PTCA 与 CABG 的成本效益

• 批准号: 6624097
• 负责人: Kevin T. Stroupe
• 金额: $ 7.39万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-04-01 至 2005-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6624097
• 关键词: cardiovascular disorder risk; coronary bypass; cost effectiveness; health care service evaluation; health economics; health services research tag; human data; human therapy evaluation; intraluminal angioplasty; myocardial ischemia /hypoxia; outcomes research; patient oriented research

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.

描述（由申请人提供）： 冠状动脉血运重建术是一项昂贵的技术，也是最昂贵的技术之一 在美国经常进行，约有 428,000 例经皮 腔内冠状动脉成形术 (PTCA) 手术和 501,000 例冠状动脉 每年进行动脉搭桥术（CABG）。估计医疗费用 每年与血运重建相关的费用从 12 到 200 亿美元不等。 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（极其严重的心绞痛 手术死亡率评估 [AWESOME] 试验）比较 PTCA 与 CABG 医学难治性高危心肌的紧急血运重建 缺血患者。这些患者是发生重大并发症的高风险人群 或手术死亡已基本上被排除在其他随机研究之外 对照试验。 AWESOME 试验的结果表明，CABG 和 PTCA 具有相似的长期生存率，但血运重建的需求更高 在 PTCA 组中。我们相信，阐明医疗保健使用模式和 这两种治疗策略在该患者群体中的护理费用 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 预计需要的资源更少，成本也低于患者 通过CABG进行血运重建。然而，为了比较总资源利用率和 PTCA 和 CABG 的费用，还必须包括后续护理的费用 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情况会更糟 与没有后续手术的同等患者相比，考虑其他因素 持续的。提供对相关决策有用的信息 为这些患者提供适当的手术策略，包括成本和 需要比较有效性（通过生存来衡量）。我们的具体 研究目标是： 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程序； 2） 比较随机分组患者之间随访护理的利用率和成本 PTCA 和 CABG； 3）比较患者的总直接医疗费用 从社会角度（包括 VA 和非 VA 成本）以及从 VA 的角度来看； 4) 确定 PTCA 与 CABG 在这些患者中的成本效益和有效性 以生存年数来衡量。

项目成果

Cost-effectiveness of coronary artery bypass grafts versus percutaneous coronary intervention for revascularization of high-risk patients.

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
• 发表时间: 2006
• 期刊: Circulation
• 影响因子: 37.8
• 作者: Stroupe,KevinT;Morrison,DouglassA;Hlatky,MarkA;Barnett,PaulG;Cao,Lishan;Lyttle,Christopher;Hynes,DeniseM;Henderson,WilliamG;InvestigatorsofVeteransAffairsCooperativeStudiesProgram#385(AWESOME:AnginaWithExtremelySeriousOp
• 通讯作者: InvestigatorsofVeteransAffairsCooperativeStudiesProgram#385(AWESOME:AnginaWithExtremelySeriousOp