title: Effectiveness and cost-effectiveness of coronary artery bypass surgery versus drug eluting stents in Armenia: a feasibility study.
abstract: We evaluated the cost-effectiveness of PCI with DES versus CABG in terms of preventing MACE (composite outcome of myocardial infarction (MI), repeat revascularization (RR), and death) after four years of procedure among patients with ischemic heart disease (IHD) treated at NMMC from January 1 2004 to December 31 2005. Patients who were more than 70 years old, who had prior revascularization (CABG or PCI), cardiogenic shock, end-stage renal disease defined as a serum creatinine>2 mg/dl, severe left ventricular dysfunction defined as a left ventricular ejection fraction<30%, or cancer at the time of admission were excluded from the sample. We also excluded patients whose procedures were covered by the Ministry of Health of Armenia (3 patients at the time of study). PCI and CABG patients were matched 1:1 for three important predictors that may potentially affect the selection of procedures and the outcomes--age (±3 years), gender, and diabetes mellitus status. Patients in the CABG group had significantly longer event-free survival times than patients in the PCI group (p<0.037, unadjusted difference) in 4.2 years of follow-up. CABG was less costly by $6,540 with preventing one more MACE compared to PCI with DES. According to our findings, CABG is a more cost-effective strategy than PCI with DES in terms of preventing RR, MI and death and saving costs. Prospective evaluation with longer time horizon would add more information to the results of our study, since the number of patients referred to the PCI replacement is increasing, the pricing is frequently changing, and there are new technologies in development.
authors.affiliation: Center for Health Services Research and Development, American University of Armenia, Yerevan, Armenia.
authors.forename: A
authors.initials: A
authors.lastname: Perikhanyan
mesh_terms: D000328:Adult; D000368:Aged; D001136:Armenia; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics; D003920:Diabetes Mellitus / Q000473:pathology; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000191:economics*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left