Coronary Artery Bypass Graft Compared to Percutaneous Coronary Interventions in Patients With Coronary Artery Disease: A Cost-Effectiveness Analysis
Authors:   Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran., Ebadifard Azar Farbod , Sheikh Gholami Saeed ,   Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran., Rezapoor Aziz ,   Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Published: February 2022

Background and Aim: Coronary Artery Diseases (CADs) affect different physical, social, and economic aspects of patients’ lives. The cost-effectiveness analysis is a way to examine both the costs and health outcomes of one or more therapeutic interventions of this disease. In other words, it compares an intervention to another one by estimating how much it costs to gain a unit of a health outcome, for instance, a life-year gained or death prevented. This study aimed to compare Coronary Artery Bypass Graft (CABG) with Percutaneous Coronary Intervention (PCI) in patients with CADs. Materials and Methods: This study is descriptive-analytical. It was conducted on 601 patients who underwent CABG (n=287) and PCI (n=314) in three aspects. The first aspect is to measure the effectiveness of CABG and PCI (cardiac mortality rate and quality of life). The second aspect is to estimate the direct costs (e.g. medical and non-medical costs) and indirect costs (e.g. productivity losses due to morbidity and mortality) based on a societal perspective. The third aspect is the cost-effectiveness analysis. The obtained data were analyzed with Markov cohort simulation using Excel and the TreeAge tool. Uncertainties related to model parameters were evaluated using 1-way and 2-way sensitivity analyses. Results: During the follow-up period, 2% and 0.8% of patients died after CABG and PCI intervention, respectively. The Mean±SD EuroQol- 5 Dimension (EQ-5D) score after 12 months was 0.72±0.15 for the CABG group and 0.66±0.19 for the PCI group. All the therapeutic strategies yielded significant improvement in all dimensions during the follow-up. The mean annual total cost for the overall sample was $6243 per patient. This cost was significantly higher among patients who underwent CABG ($7234 per patient) than PCI ($5252 per patient). Direct costs accounted for 90%, and indirect costs accounted for 10% of the total costs. And the cost-effectiveness threshold was $14375. The Incremental Cost- Effectiveness Rate (ICER) in reducing mortality rate and increasing Quality of Life (QoL) was $-942.7 and $106050, respectively. Conclusion: The present study found which intervention (PCI and CABG) had better cost-effectiveness in CAD patients. PCI intervention is more cost-effective than CABG in reducing mortality rate and increasing quality of life. This study tries to resolve the previous controversies regarding the most appropriate treatment for patients with coronary artery disease. It can have significant policy and clinical implications for health policymakers, cardiologists, and health managers.