title: Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents in patients with multivessel coronary artery disease compared to coronary artery bypass surgery five-years after intervention.
abstract: OBJECTIVE
  Cost-effectiveness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES), and coronary artery bypass surgery (CABG) was analyzed in patients with multivessel coronary artery disease over a 5-year follow-up.
  
  
  BACKGROUND
  DES implantation reducing revascularization rate and associated costs might be attractive for health economics as compared to CABG.
  
  
  METHODS
  Consecutive patients with multivessel DES-PCI (n = 114, 3.3 ± 1.2 DES/patient) or CABG (n = 85, 2.7 ± 0.9 grafts/patient) were included prospectively. Primary endpoint was cost-benefit of multivessel DES-PCI over CABG, and the incremental cost-effectiveness ratio (ICER) was calculated. Secondary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE), including acute myocardial infarction (AMI), all-cause death, revascularization, and stroke.
  
  
  RESULTS
  Despite multiple uses for DES, in-hospital costs were significantly less for PCI than CABG, with 4551 €/patient difference between the groups. At 5-years, the overall costs remained higher for CABG patients (mean difference 5400 € between groups). Cost-effectiveness planes including all patients or subgroups of elderly patients, diabetic patients, or Syntax score >32 indicated that CABG is a more effective, more costly treatment mode for multivessel disease. At the 5-year follow-up, a higher incidence of MACCE (37.7% vs. 25.8%; log rank P = 0.048) and a trend towards more AMI/death/stroke (25.4% vs. 21.2%, log rank P = 0.359) was observed in PCI as compared to CABG. ICER indicated 45615 € or 126683 € to prevent one MACCE or AMI/death/stroke if CABG is performed.
  
  
  CONCLUSIONS
  Cost-effectiveness analysis of DES-PCI vs. CABG demonstrated that CABG is the most effective, but most costly, treatment for preventing MACCE in patients with multivessel disease.
authors.affiliation: Department of Cardiology, Medical University of Vienna, Wahringer Gürtel 18-20, A-1090 Vienna, Austria.
authors.forename: Lisa
authors.initials: L
authors.lastname: Krenn
authors.forename: Christoph
authors.initials: C
authors.lastname: Kopp
authors.forename: Dietmar
authors.initials: D
authors.lastname: Glogar
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
authors.forename: Georg
authors.initials: G
authors.lastname: Delle-Karth
authors.forename: Thomas
authors.initials: T
authors.lastname: Neunteufl
authors.forename: Gerhard
authors.initials: G
authors.lastname: Kreiner
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kaider
authors.forename: Jutta
authors.initials: J
authors.lastname: Bergler-Klein
authors.forename: Aliasghar
authors.initials: A
authors.lastname: Khorsand
authors.forename: Mariam
authors.initials: M
authors.lastname: Nikfardjam
authors.forename: Günther
authors.initials: G
authors.lastname: Laufer
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Mariann
authors.initials: M
authors.lastname: Gyöngyösi
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000191:economics* / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery bypass surgery; cost-benefit; drug-eluting stent; follow-up study; percutaneous coronary intervention