title: Economic outcomes of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with left main or three-vessel coronary artery disease: one-year results from the SYNTAX trial.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of alternative approaches to revascularization for patients with three-vessel or left main coronary artery disease (CAD).
  
  
  BACKGROUND
  Previous studies have demonstrated that, despite higher initial costs, long-term costs with bypass surgery (CABG) in multivessel CAD are similar to those for percutaneous coronary intervention (PCI). The impact of drug-eluting stents (DES) on these results is unknown.
  
  
  METHODS
  The SYNTAX trial randomized 1,800 patients with left main or three-vessel CAD to either CABG (n = 897) or PCI using paclitaxel-eluting stents (n = 903). Resource utilization data were collected prospectively for all patients, and cumulative 1-year costs were assessed from the perspective of the U.S. healthcare system.
  
  
  RESULTS
  Total costs for the initial hospitalization were $5,693/patient higher with CABG, whereas follow-up costs were $2,282/patient higher with PCI due mainly to more frequent revascularization procedures and higher outpatient medication costs. Total 1-year costs were thus $3,590/patient higher with CABG, while quality-adjusted life expectancy was slightly higher with PCI. Although PCI was an economically dominant strategy for the overall population, cost-effectiveness varied considerably according to angiographic complexity. For patients with high angiographic complexity (SYNTAX score > 32), total 1-year costs were similar for CABG and PCI, and the incremental cost-effectiveness ratio for CABG was $43,486 per quality-adjusted life-year gained.
  
  
  CONCLUSIONS
  Among patients with three-vessel or left main CAD, PCI is an economically attractive strategy over the first year for patients with low and moderate angiographic complexity, while CABG is favored among patients with high angiographic complexity.
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64111, USA. dcohen@saint-lukes.org
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Tara A
authors.initials: TA
authors.lastname: Lavelle
authors.forename: Ben
authors.initials: B
authors.lastname: Van Hout
authors.forename: Haiyan
authors.initials: H
authors.lastname: Li
authors.forename: Yang
authors.initials: Y
authors.lastname: Lei
authors.forename: Katherine
authors.initials: K
authors.lastname: Robertus
authors.forename: Duane
authors.initials: D
authors.lastname: Pinto
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Magnuson
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Mcgarry
authors.forename: Scott K
authors.initials: SK
authors.lastname: Lucas
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Horwitz
authors.forename: Carl A
authors.initials: CA
authors.lastname: Henry
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome