title: Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with 3-vessel or left main coronary artery disease: final results from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial.
abstract: BACKGROUND
  The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial demonstrated that in patients with 3-vessel or left main coronary artery disease, coronary artery bypass graft surgery (CABG) was associated with a lower rate of cardiovascular death, myocardial infarction, stroke, or repeat revascularization compared with percutaneous coronary revascularization with drug-eluting stents (DES-PCI)). The long-term cost-effectiveness of these strategies is unknown.
  
  
  RESULTS
  Between 2005 and 2007, 1800 patients with left main or 3-vessel coronary artery disease were randomized to CABG (n=897) or DES-PCI (n=903). Costs were assessed from a US perspective, and health state utilities were evaluated with the EuroQOL questionnaire. A patient-level microsimulation model based on the 5-year in-trial data was used to extrapolate costs, life expectancy, and quality-adjusted life expectancy over a lifetime horizon. Although initial procedural costs were $3415 per patient lower with CABG, total hospitalization costs were $10 036 per patient higher. Over the next 5 years, follow-up costs were higher with DES-PCI as a result of more frequent hospitalizations, revascularization procedures, and higher medication costs. Over a lifetime horizon, CABG remained more costly than DES-PCI, but the incremental cost-effectiveness ratio was favorable ($16 537 per quality-adjusted life-year gained) and remained <$20 000 per quality-adjusted life-year in most bootstrap replicates. Results were consistent across a wide range of assumptions about the long-term effect of CABG versus DES-PCI on events and costs. In patients with left main disease or a SYNTAX score ≤22, however, DES-PCI was economically dominant compared with CABG, although these findings were less certain.
  
  
  CONCLUSIONS
  For most patients with 3-vessel or left main coronary artery disease, CABG is a clinically and economically attractive revascularization strategy compared with DES-PCI. However, among patients with less complex disease, DES-PCI may be preferred on both clinical and economic grounds.
  
  
  BACKGROUND
  www.clinicaltrials.gov. Unique identifier: NCT00114972.
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.). dcohen@saint-lukes.org.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Ruben L
authors.initials: RL
authors.lastname: Osnabrugge
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Magnuson
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Kaijun
authors.initials: K
authors.lastname: Wang
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Haiyan
authors.initials: H
authors.lastname: Li
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Khaja
authors.initials: K
authors.lastname: Chinnakondepalli
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Duane
authors.initials: D
authors.lastname: Pinto
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Mouin S
authors.initials: MS
authors.lastname: Abdallah
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Vilain
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: From Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universität Leipzig, Leipzig, Germany (F.W.M.).
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D001026:Coronary Artery Bypass / Q000191:economics* / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000191:economics / Q000401:mortality / Q000601:surgery; D003331:Coronary Vessels / Q000601:surgery; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000191:economics* / Q000379:methods* / Q000401:mortality; D010820:Physicians / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
keywords: coronary artery bypass; cost-benefit analysis; drug-eluting stents; percutaneous coronary intervention; randomized, controlled trials as topic