title: Cost-effectiveness of revascularization strategies: the ASCERT study.
abstract: BACKGROUND
  ASCERT (American College of Cardiology Foundation and the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies) was a large observational study designed to compare the long-term effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) to treat coronary artery disease (CAD) over 4 to 5 years.
  
  
  OBJECTIVE
  This study examined the cost-effectiveness of CABG versus PCI for stable ischemic heart disease.
  
  
  METHODS
  The Society of Thoracic Surgeons and American College of Cardiology Foundation databases were linked to the Centers for Medicare and Medicaid Services claims data. Costs for the index and observation period (2004 to 2008) hospitalizations were assessed by diagnosis-related group Medicare reimbursement rates; costs beyond the observation period were estimated from average Medicare participant per capita expenditure. Effectiveness was measured via mortality and life-expectancy data. Cost and effectiveness comparisons were adjusted using propensity score matching with the incremental cost-effectiveness ratio expressed as cost per quality-adjusted life-year gained.
  
  
  RESULTS
  CABG patients (n = 86,244) and PCI patients (n = 103,549) were at least 65 years old with 2- or 3-vessel coronary artery disease. Adjusted costs were higher for CABG for the index hospitalization, study period, and lifetime by $10,670, $8,145, and $11,575, respectively. Patients undergoing CABG gained an adjusted average of 0.2525 and 0.3801 life-years relative to PCI over the observation period and lifetime, respectively. The life-time incremental cost-effectiveness ratio of CABG compared to PCI was $30,454/QALY gained.
  
  
  CONCLUSIONS
  Over a period of 4 years or longer, patients undergoing CABG had better outcomes but at higher costs than those undergoing PCI.
authors.affiliation: Value Institute, Christiana Care Health System, Newark, Delaware. Electronic address: zzgfang@hotmail.com.
authors.forename: Zugui
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Value Institute, Christiana Care Health System, Newark, Delaware.
authors.forename: Paul
authors.initials: P
authors.lastname: Kolm
authors.affiliation: Department of Outcomes, Health Economics, and Quality of Life, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Grau-Sepulveda
authors.affiliation: Department of Research Study, American College of Cardiology, Washington, DC.
authors.forename: Angelo
authors.initials: A
authors.lastname: Ponirakis
authors.affiliation: Department of Outcomes, Health Economics, and Quality of Life, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: Section of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
authors.forename: Lloyd W
authors.initials: LW
authors.lastname: Klein
authors.affiliation: Department of Clinical Informatics, California Pacific Medical Center, San Francisco, California.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.affiliation: Section of Cardiology, Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Charles
authors.initials: C
authors.lastname: McKay
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Section of Cardiology, Denver Department of Veterans Affairs Medical Center, Denver, Colorado.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.affiliation: Department of Interventional Cardiovascular Research, Lenox Hill Heart and Vascular Institute of New York, New York, New York.
authors.forename: Kirk N
authors.initials: KN
authors.lastname: Garratt
authors.affiliation: Department of Health Research and Policy, Stanford University, Palo Alto, California.
authors.forename: Mark
authors.initials: M
authors.lastname: Hlatky
authors.affiliation: Department of Surgery, University of Florida Shands Jacksonville, Jacksonville, Florida.
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
authors.affiliation: Value Institute, Christiana Care Health System, Newark, Delaware.
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D000368:Aged; D057186:Comparative Effectiveness Research; D001026:Coronary Artery Bypass / Q000191:economics*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008017:Life Expectancy; D008297:Male; D006278:Medicare; D017202:Myocardial Ischemia / Q000191:economics / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000191:economics*; D057216:Propensity Score; D019057:Quality-Adjusted Life Years; D014481:United States
keywords: coronary artery bypass graft; incremental cost-effectiveness ratio; percutaneous coronary intervention; stable ischemic heart disease