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

描述（由申请人提供）：

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.