Coronary bypass surgery versus percutaneous coronary intervention: cost-effectiveness in Iran: a study in patients with multivessel coronary artery disease.
OBJECTIVE
The aim of this study was to evaluate cost effectiveness of coronary artery bypass graft (CABG) versus percutaneous coronary intervention (PCI) with stenting from Iran society perspective.


METHODS
A retrospective study was carried out to estimate the annual cost and health related quality of life (HRQoL) of 109 patients who underwent coronary revascularization (PCI [n = 75] and CABG [n = 34]). A Markov model has been developed to determine the cost effectiveness of CABG compared with PCI. We used the model to calculate lifetime costs, life-years (LYs), and quality-adjusted life-years (QALYs) of each strategy. We also used probabilistic sensitivity analysis to test model robustness.


RESULTS
We found that discounted QALY lived per person in CABG versus PCI group in 5 years, 10 years, and lifetime time horizon were (3.8 ± 0.13 versus 3.88 ± 0.14), (6.4 ± 0.23 versus 6.33 ± 0.22), and (8.74 ± 0.29 versus 8.33 ± 0.27), respectively. The estimated medical cost of CABG and PCI per patient in 5 years, 10 years, and lifetime time horizon were (USD 6,819 ± 765 versus 9,011 ± 1,816), (USD 8,852 ± 1,348 versus 12,034 ± 2,375), and (USD 14,037± 4,201 versus 18,798 ± 5,821), respectively. The incremental cost-effectiveness ratio results showed CABG is a dominate alternative in 10 years and lifetime time horizon.


CONCLUSIONS
This study demonstrated that despite higher initial cost and lower HRQoL, CABG is a cost-effective revascularization strategy compared with PCI for patients with multivessel coronary artery disease in long-term.
Health Economics Research Unit,Institute of Applied Health Sciences,University of Aberdeen;Health Management and Economics Research Center,School of Health Management and Information Sciences,Iran University of Medical Sciencesm.javanbakht@abdn.ac.uk.
Mehdi
M
Javanbakht
Isfahan University of Medical Sciences.
Razieh Yazdani
RY
Bakhsh
Tehran University of Medical Sciences.
Atefeh
A
Mashayekhi
Health Economics Department,School of Health Management and Information Sciences,Iran University of Medical Sciences.
Hossein
H
Ghaderi
Cardiac Rehabilitation Research Center,Isfahan Cardiovascular Research Institute,Isfahan University of Medical Sciences.
Masoumeh
M
Sadeghi
D001026:Coronary Artery Bypass / Q000191:economics*; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies
Quality adjusted life years