title: On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial.
abstract: BACKGROUND
  Questions have been raised about the costs and outcomes for patients receiving on-pump and off-pump coronary artery bypass graft surgery. As part of the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) multisite trial, a cost-effectiveness analysis was performed to compare on-pump versus off-pump patients' quality-adjusted life-years and costs at 1 year.
  
  
  METHODS
  One-year outcomes and costs (standardized to 2010 dollars) were estimated in multivariate regression models, controlling for site and baseline patient factors. The 1-year incremental cost-effectiveness analysis ratio with 95% confidence intervals was calculated using bootstrapping.
  
  
  RESULTS
  Eighteen centers randomly assigned 2,203 participants to on-pump (n=1,099) versus off-pump (n=1,104) coronary artery bypass graft surgery. Both groups' quality of life improved significantly after surgery (p<0.01) compared with baseline, but no differences were found between treatment groups. Adjusted cost of the index coronary artery bypass graft surgery hospitalization was $36,046 on-pump and $36,536 off-pump (p=0.16). At 1 year, on-pump adjusted cost was $56,023 versus $59,623 off-pump (p=0.046). Off-pump-to-on-pump conversions after first distal anastomosis (4.8%) had significantly higher 1-year costs. Excluding conversions, there were no significant differences between treatments for index hospitalization or 1-year total costs.
  
  
  CONCLUSIONS
  At 1 year, off-pump coronary artery bypass graft surgery was more expensive than on-pump when late off-pump-to-on-pump conversions were included. Excluding late conversions, there was no difference in quality-adjusted life-years or costs.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier NCT00032630; http://clinicaltrials.gov/ct2/show/NCT00032630.
authors.affiliation: VA Palo Alto Health Economics Resource Center, Menlo Park, California 94025, USA. todd.wagner@va.gov
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler
authors.forename: Muath
authors.initials: M
authors.lastname: Bishawi
authors.forename: Janet H
authors.initials: JH
authors.lastname: Baltz
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.forename: Jacquelyn A
authors.initials: JA
authors.lastname: Quin
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.forename: A Laurie W
authors.initials: AL
authors.lastname: Shroyer
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000191:economics* / Q000379:methods; D017023:Coronary Angiography / Q000191:economics / Q000379:methods; D001026:Coronary Artery Bypass / Q000191:economics / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000191:economics* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis; D018570:Risk Assessment; D014481:United States
keywords: 23