BACKGROUND: The economic outcomes of clinical management strategies are important in assessing their value to @entity1 . METHODS AND RESULTS: Bypass Angioplasty Revascularization Investigation 2 @entity6 (BARI 2D) randomized @entity1 with @entity6 and angiographically documented, stable @entity301 to strategies of (1) prompt revascularization versus medical therapy with delayed revascularization as needed to relieve symptoms and (2) insulin sensitization versus insulin provision. Before randomization, the physician declared whether coronary artery bypass grafting or percutaneous coronary intervention would be used if the @entity1 were assigned to revascularization. We followed 2005 @entity1 for medical utilization and costs and assessed the cost-effectiveness of these management strategies. Medical costs were higher for revascularization than medical therapy, with a significant interaction with the intended method of revascularization (P<0.0001). In the coronary artery bypass grafting stratum, 4-year costs were  80 900 for revascularization versus  60 600 for medical therapy (P<0.0001). In the percutaneous coronary intervention stratum, costs were  73 400 for revascularization versus  67 800 for medical therapy (P<0.02). Costs also were higher for insulin sensitization ( 71 300) versus insulin provision ( 70 200). Other factors that significantly (P<0.05) and independently increased cost included insulin use and dose at baseline, female sex, white race, body mass index > or =30, and @entity633 . Cost-effectiveness based on 4-year data favored the strategy of medical therapy over prompt revascularization and the strategy of insulin provision over insulin sensitization. Lifetime projections of cost-effectiveness showed that medical therapy was cost-effective compared with revascularization in the percutaneous coronary intervention stratum ( 600 per life-year added) with high confidence. Lifetime projections suggest that revascularization may be cost-effective in the coronary artery bypass grafting stratum ( 47 000 per life-year added) but with lower confidence. CONCLUSIONS: Prompt coronary revascularization significantly increases costs among @entity1 with @entity6 and stable @entity301 . The strategy of medical therapy (with delayed revascularization as needed) appears to be cost-effective compared with the strategy of prompt coronary revascularization among @entity1 identified a priori as suitable for percutaneous coronary intervention.

Economic outcomes of treatment strategies for @entity6 and coronary artery disease in the Bypass Angioplasty Revascularization Investigation 2 XXXX trial.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity633 :: ('MESH:D000419', 'Disease') :: ['albuminuria'] @entity6 :: ('MESH:D003920', 'Disease') :: ['Diabetes', 'type 2 diabetes mellitus'] @entity301 :: ('MESH:D003327', 'Disease') :: ['coronary disease']
@entity6 :: (MESH:D003920,Disease) :: ['Diabetes']
