Potential shift from coronary bypass surgery to percutaneous coronary intervention for multivessel disease and its economic impact in the drug-eluting stent era.
BACKGROUND
Drug-eluting stents (DES) may promote percutaneous coronary intervention (PCI) procedures in patients traditionally referred for coronary artery bypass graft (CABG) surgery and may save money.


OBJECTIVE
The purpose of the present study was to quantify the potential shift from CABG surgery to multivessel PCI in the DES era and to model the economic consequences.


METHODS
Based on predefined criteria, the feasibility of PCI was evaluated in patients with multivessel coronary artery disease who underwent CABG surgery before the availability of DES at the Centre Hospitalier de l'Université de Montréal's Notre-Dame Hospital (Montreal, Quebec). Modelling was used to evaluate the potential cost savings using multivessel PCI instead of CABG surgery. Equal one-year outcomes in both groups were assumed, with the exception of a 10% repeat revascularization (RR) rate in the DES group and a 4% RR rate in the CABG group. The impact of those assumptions was evaluated using 1000 Monte Carlo simulations.


RESULTS
The authors retrospectively evaluated that, of 289 patients who underwent CABG without concomitant valve surgery between January and December 2003, only 22 patients (8%) were good candidates for multivessel DES implantation. The procedures would have involved an average of 3.6 DES per patient. The average cost per revascularization procedure was $14,402 with surgery and $11,220 for multivessel DES implantation (using $2,200 DES), leading to a savings of $3,182 per patient. However, after including RR procedures, PCI would only have been associated with savings of $812 per surgery avoided. Monte Carlo analysis revealed that surgery may be less expensive than PCI in 36% of patients.


CONCLUSIONS
Most patients who underwent CABG surgery in 2003 were retrospectively judged to be ineligible for multivessel PCI with DES. In the rare eligible patient, multivessel PCI with DES is not expected to produce savings to health care costs in Canada unless the DES purchase cost continues to decrease.
Poulin
Frédéric
F
Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
Rinfret
Stéphane
S
Gobeil
François
F
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D020099:Coated Materials, Biocompatible / Q000191:economics*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec; D012189:Retrospective Studies; D015607:Stents / Q000191:economics*; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible