title: Economic evaluation of endoscopic versus open vein harvest for coronary artery bypass grafting.
abstract: BACKGROUND
  A short saphenous vein segment is commonly used as a conduit for coronary artery bypass grafting, and clinicians must decide whether to obtain it by performing open (OVH) or endoscopic vein harvest (EVH). We conducted a health economic evaluation, using data on resource usage collected alongside a randomized controlled trial, to investigate whether EVH is cost-effective compared with OVH.
  
  
  METHODS
  Analyses were performed in accordance with international guidelines for health economic evaluations. We constructed 3 cost-levels as the current literature is inconclusive as to which resource consumptions differ significantly between harvesting methods. Outcomes were measured as purulent infections avoided in the cost-effectiveness analysis and for the cost-utility analysis we estimated quality-adjusted life-years gained. Results were presented as incremental cost-effectiveness ratios: ie, the extra cost of obtaining one extra quality-adjusted life-year and the extra cost of avoiding one purulent infection. To handle uncertainties, we performed bias corrected bootstrap analyses on 5,000 resamples and constructed cost-effectiveness acceptability curves.
  
  
  RESULTS
  The incremental cost-effectiveness ratio was $79,391/quality-adjusted life-year and $1,970/purulent infection avoided when costs and outcomes within 35 days postoperatively were compared. Within 35 days postoperatively, EVH was less than 1% cost-effective at a willingness-to-pay threshold of $50,000/quality-adjusted life-year.
  
  
  CONCLUSIONS
  The EVH was not cost-effective within 35 days postoperatively. Future studies should investigate long-term cost effectiveness.
authors.affiliation: Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg Hospital, Aalborg, Denmark. lars.oddershede@gmail.com
authors.forename: Lars
authors.initials: L
authors.lastname: Oddershede
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Andreasen
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Brocki
authors.forename: Lars
authors.initials: L
authors.lastname: Ehlers
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012501:Saphenous Vein / Q000601:surgery* / Q000637:transplantation; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000191:economics* / Q000379:methods