title: Treatment for stable coronary artery disease: a network meta-analysis of cost-effectiveness studies.
abstract: OBJECTIVE
  Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG).
  
  
  METHODS
  RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs.
  
  
  RESULTS
  Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3-year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG.
  
  
  CONCLUSIONS
  Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina.
authors.affiliation: Pharmacie, Hôpital Européen Georges Pompidou, APHP, Paris, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Caruba
authors.affiliation: URC Hôpital Henri Mondor, APHP, Créteil, France; Equipe 22, Centre de Recherche des Cordeliers, UMRS 762 INSERM, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Katsahian
authors.affiliation: URC Hôpital Henri Mondor, APHP, Créteil, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Schramm
authors.affiliation: URC Hôpital Henri Mondor, APHP, Créteil, France.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Charles Nelson
authors.affiliation: Equipe 22, Centre de Recherche des Cordeliers, UMRS 762 INSERM, Paris, France; Département de Santé Publique et Informatique, Hôpital Européen Georges Pompidou, APHP, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Durieux
authors.affiliation: Faculté de Pharmacie, Université René Descartes, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Bégué
authors.affiliation: Cardiologie, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, Nancy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.affiliation: Cardiologie, Hôpital Ambroise Paré, APHP, Boulogne Billancourt, France; Université de Versailles-Saint Quentin, Montigny-Le-Bretonneux, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubourg
authors.affiliation: Cardiologie, Hôpital Européen Georges Pompidou, APHP, Paris, France; Faculté de Médecine, Université René Descartes, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Pharmacie, Hôpital Européen Georges Pompidou, APHP, Paris, France; Equipe 22, Centre de Recherche des Cordeliers, UMRS 762 INSERM, Paris, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Sabatier
mesh_terms: D001026:Coronary Artery Bypass / Q000191:economics*; D003324:Coronary Artery Disease / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000191:economics*