[Cost-effectiveness analysis of an invasive therapeutic approach to coronary disease].
Surgical or percutaneous revascularisation techniques are increasingly used. Percutaneous angioplasty is more efficient than medical treatment for control of angina symptoms, but it does not influence mortality or infarction in a low-risk population. Surgery is associated with a significant decrease in mortality after 5 years, when compared with a strategy of initial medical treatment. Benefit is maximum in high-risk patients. In selected patients with single- or multivessel disease, several studies have demonstrated that surgery and angioplasty have a similar long-term effect on mortality and/or myocardial infarction. The costs of angioplasty are lower than these of surgery, but the percutaneous approach is limited by a more frequent need for reintervention. In acute myocardial infarction, direct PTCA appears to be associated with a lower mortality than thrombolysis, and hemorrhagic events are less frequent. The cost of an invasive strategy is not necessarily higher than that of medical treatment, because the duration of the initial hospital stay and the need for further hospitalizations are reduced.
Urban
P
P
Cardiologie, Hôpital cantonal universitaire, Genève.
D000787:Angina Pectoris / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000191:economics* / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003362:Cost-Benefit Analysis; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D011379:Prognosis; D015912:Thrombolytic Therapy / Q000191:economics