title: Cost and cost-effectiveness of cardiac surgery in elderly patients.
abstract: OBJECTIVE
  Cost-effectiveness of heart surgery for elderly patients is still poorly defined. We evaluated outcome, quality of life (QoL), cost, and cost-effectiveness of octogenarians undergoing cardiac surgery.
  
  
  METHODS
  One thousand six hundred forty octogenarians undergoing various cardiac surgical procedures were prospectively studied between January 1998 and January 2009 and compared with similar patients aged 70 to 79 years. Several questionnaires were used to assess QoL. Six hundred age- and sex- matched healthy octogenarians and three hundred forty patients older than 80 years with medically treated valvular or coronary artery disease were healthy and unoperated control groups, respectively. In-hospital costs were obtained from the hospital's financial accounting department and cost-effectiveness was estimated and expressed as cost/QoL-adjusted life year (QALY) and cost-effectiveness ratio.
  
  
  RESULTS
  Significant improvements occurred in elderly patients in Role Physical (P < .001), Bodily Pain (P < .001), General Health (P = .004), Social Functioning (P < .001), and Role Emotional (P < .001), whereas Physical Functioning, Vitality, and Mental Health did not change (difference not signficant). Total direct costs were $5293 higher in the octogenarian group. Cost-effectiveness was $1391/QALY for elderly surgical patients, $516/QALY for younger cardiac surgical patients (P < .001 vs elderly), $897/QALY for untreated control group, and $641/QALY for healthy control group (P < .001 vs elderly surgical patients). The cost-effectiveness ratio for octogenarians was $94,426.
  
  
  CONCLUSIONS
  Our findings confirm that cardiac surgery in elderly patients remains controversial from a cost-effectiveness standpoint, making econometric analysis an important component for any future evaluation of novel cardiovascular therapies. Our findings need to be confirmed by additional multicenter studies.
authors.affiliation: Cardiac Surgery Unit, Careggi Hospital, Florence, Italy. sandro.gelsomino@libero.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Masullo
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lucà
authors.forename: Jos
authors.initials: J
authors.lastname: Maessen
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D005260:Female; D006299:Health Services for the Aged / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D018579:Patient Selection; D016016:Proportional Hazards Models; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome