title: Cost-effectiveness of percutaneous coronary intervention in optimally treated stable coronary patients.
abstract: BACKGROUND
  The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluations) trial compared the effect of percutaneous coronary intervention (PCI) plus optimal medical therapy with optimal medical therapy alone on cardiovascular events in 2287 patients with stable coronary disease. After 4.6 years, there was no difference in the primary end point of death or myocardial infarction, although PCI improved quality of life. The present study evaluated the relative cost and cost-effectiveness of PCI in the COURAGE trial.
  
  
  RESULTS
  Resource use was assessed by diagnosis-related group for hospitalizations and by current procedural terminology code for outpatient visits and tests and then converted to costs by use of 2004 Medicare payments. Medication costs were assessed with the Red Book average wholesale price. Life expectancy beyond the trial was estimated from Framingham survival data. Utilities were assessed by the standard gamble method. The incremental cost-effectiveness ratio was expressed as cost per life-year and cost per quality-adjusted life-year gained. The added cost of PCI was approximately $10,000, without significant gain in life-years or quality-adjusted life-years. The incremental cost-effectiveness ratio varied from just over $168,000 to just under $300,000 per life-year or quality-adjusted life-year gained with PCI. A large minority of the distributions found that medical therapy alone offered better outcome at lower cost. The costs per patient for a significant improvement in angina frequency, physical limitation, and quality of life were $154,580, $112,876, and $124,233, respectively.
  
  
  CONCLUSIONS
  The COURAGE trial did not find the addition of PCI to optimal medical therapy to be a cost-effective initial management strategy for symptomatic, chronic coronary artery disease.
authors.affiliation: Christiana Care Health System, Newark, DE 19718, USA. wweintraub@christianacare.org
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
authors.forename: Zugui
authors.initials: Z
authors.lastname: Zhang
authors.forename: Paul
authors.initials: P
authors.lastname: Kolm
authors.forename: Zefeng
authors.initials: Z
authors.lastname: Zhang
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Pamela
authors.initials: P
authors.lastname: Hartigan
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.forename: Claudine
authors.initials: C
authors.lastname: Jurkovitz
authors.forename: Jim
authors.initials: J
authors.lastname: Bowen
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.forename: Robert
authors.initials: R
authors.lastname: O'Rourke
authors.forename: Marcin
authors.initials: M
authors.lastname: Dada
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
authors.forename: Paul G
authors.initials: PG
authors.lastname: Barnett
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000639:trends; D003324:Coronary Artery Disease / Q000191:economics* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life