Cost-effectiveness of coronary bypass surgery versus medicine for ischemic cardiomyopathy

Compared to medical treatment alone (MED) in patients with ischemic cardiomyopathy and decreased left ventricular function (ejection fraction ≤ 35%), the randomized clinical trial STICH (surgical treatment of ischemic heart failure) showed that all-cause mortality rates were reduced at 10 years by coronary artery bypass graft (CABG). The researchers explored the financial aspects of these results. To estimate the lifetime expenditures and benefits of CABG and MED, the researchers used patient-level resource utilization and accumulated clinical data from the STICH trial. They performed the estimation using a patient-level decision simulation model. During follow-up to the trial, they applied externally derived US cost weights to the resource use count and used them to calculate patient-level costs. They also applied a 3% discount on future expenses and benefits. The main outcome was incremental profitability, which they examined from the perspective of the US healthcare industry.

The researchers estimated 6.53 quality-adjusted life years (95% CI, 5.70 to 7.53) and a lifetime expenditure of $140,059 (95% CI, $106,401 to $180,992 ) for the CAP. In contrast, it was 5.52 (95% CI, 5.06 to 6.09) quality-adjusted life years and the lifetime cost of $74,894 (95% CI, $58,372 to 93 $541) for MED. Compared to MED, the incremental cost-effectiveness ratio of CABG was $63,989 per quality-adjusted life year gained. The researchers found that CABG was preferred over MED in 87% of the microsimulations from a financial perspective, because the societal willingness-to-pay threshold was $100,000 per quality-adjusted life year gained. At current US standards of value, the researchers concluded that patients with ischemic cardiomyopathy and reduced left ventricular function preferred CABG because it was financially lucrative.

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