title: Coronary artery bypass grafting with minimal versus conventional extracorporeal circulation; an economic analysis.
abstract: BACKGROUND
  This study aims to develop a methodological framework for the comparative economic evaluation between Minimal Extracorporeal Circulation (MECC) versus conventional Extracorporeal Circulation (CECC) in patients undergoing coronary artery bypass grafting (CABG) in different healthcare systems. Moreover, we evaluate the cost-effectiveness ratio of alternative comparators in the healthcare setting of Greece, Germany, the Netherlands and Switzerland.
  
  
  METHODS
  The effectiveness data utilized were derived from a recent meta-analysis which incorporated 24 randomized clinical trials. Total therapy cost per patient reflects all resources expensed in delivery of therapy and the management of any adverse events, including drugs, diagnostics tests, materials, devices, blood units, the utilization of operating theaters, intensive care units, and wards. Perioperative mortality was used as the primary health outcome to estimate life years gained in treatment arms. Bias-corrected uncertainty intervals were calculated using the percentile method of non-parametric Monte-Carlo simulation.
  
  
  RESULTS
  The MECC circuit was more expensive than CECC, with a difference ranging from €180 to €600 depending on the country. However, in terms of total therapy cost per patient the comparison favored MECC in all countries. Specifically it was associated with a reduction of €635 in Greece, €297 in Germany, €1590 in the Netherlands and €375 in Switzerland. In terms of effectiveness, the total life-years gained were slightly higher in favor of MECC.
  
  
  CONCLUSIONS
  Surgery with MECC may be dominant (lower cost and higher effectiveness) compared to CECC in coronary revascularization procedures and therefore it represents an attractive new option relative to conventional extracorporeal circulation for CABG.
authors.affiliation: Cardiothoracic Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Anastasiadis
authors.forename: V
authors.initials: V
authors.lastname: Fragoulakis
authors.forename: P
authors.initials: P
authors.lastname: Antonitsis
authors.forename: N
authors.initials: N
authors.lastname: Maniadakis
mesh_terms: D001026:Coronary Artery Bypass / Q000191:economics* / Q000379:methods / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005112:Extracorporeal Circulation / Q000191:economics* / Q000379:methods / Q000401:mortality; D005858:Germany / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D017059:Models, Econometric; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome; D035501:Uncertainty
keywords: Coronary artery bypass grafting; Economic evaluation; Minimal extracorporeal circulation