title: Cost-effectiveness analysis for surgical, angioplasty, or medical therapeutics for coronary artery disease: 5-year follow-up of medicine, angioplasty, or surgery study (MASS) II trial.
abstract: BACKGROUND
  The Second Medicine, Angioplasty, or Surgery Study (MASS II) included patients with multivessel coronary artery disease and normal systolic ventricular function. Patients underwent coronary artery bypass graft surgery (CABG, n=203), percutaneous coronary intervention (PCI, n=205), or medical treatment alone (MT, n=203). This investigation compares the economic outcome at 5-year follow-up of the 3 therapeutic strategies.
  
  
  RESULTS
  We analyzed cumulative costs during a 5-year follow-up period. To analyze the cost-effectiveness, adjustment was made on the cumulative costs for average event-free time and angina-free proportion. Respectively, for event-free survival and event plus angina-free survival, MT presented 3.79 quality-adjusted life-years and 2.07 quality-adjusted life-years; PCI presented 3.59 and 2.77 quality-adjusted life-years; and CABG demonstrated 4.4 and 2.81 quality-adjusted life-years. The event-free costs were $9071.00 for MT; $19,967.00 for PCI; and $18,263.00 for CABG. The paired comparison of the event-free costs showed that there was a significant difference favoring MT versus PCI (P<0.01) and versus CABG (P<0.01) and CABG versus PCI (P=0.01). The event-free plus angina-free costs were $16,553.00, $25,831.00, and $24,614.00, respectively. The paired comparison of the event-free plus angina-free costs showed that there was a significant difference favoring MT versus PCI (P=0.04), and versus CABG (P<0.001); there was no difference between CABG and PCI (P>0.05).
  
  
  CONCLUSIONS
  In the long-term economic analysis, for the prevention of a composite primary end point, MT was more cost effective than CABG, and CABG was more cost-effective than PCI.
  
  
  BACKGROUND
  www.controlled-trials.com.
  
  
  BACKGROUND
  ISRCTN66068876.
authors.affiliation: Department of Atherosclerosis, Heart Institute of the University of São Paulo, São Paulo, Brazil.
authors.forename: Ricardo D'Oliveira
authors.initials: RD
authors.lastname: Vieira
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.forename: Mark
authors.initials: M
authors.lastname: Hlatky
authors.forename: Desiderio
authors.initials: D
authors.lastname: Favarato
authors.forename: Paulo Cury
authors.initials: PC
authors.lastname: Rezende
authors.forename: Cibele Larrosa
authors.initials: CL
authors.lastname: Garzillo
authors.forename: Eduardo Gomes
authors.initials: EG
authors.lastname: Lima
authors.forename: Paulo Rogério
authors.initials: PR
authors.lastname: Soares
authors.forename: Alexandre Ciappina
authors.initials: AC
authors.lastname: Hueb
authors.forename: Alexandre Costa
authors.initials: AC
authors.lastname: Pereira
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000191:economics* / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000191:economics* / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy; D003362:Cost-Benefit Analysis; D003935:Diagnostic Techniques, Cardiovascular / Q000191:economics; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data*; D009819:Office Visits / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents