Expected cost-effectiveness of percutaneous coronary intervention versus bypass surgery for the treatment of left main, three vessel, and multi-vessel disease that involves the ostium of the right coronary artery.

Bardoel, T.L.J. (2015) Expected cost-effectiveness of percutaneous coronary intervention versus bypass surgery for the treatment of left main, three vessel, and multi-vessel disease that involves the ostium of the right coronary artery.

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Abstract:Objective: The aim of this study is to present the cost-effectiveness of the percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for the following three study populations: patients with left main (LM) and/ or three vessel disease, and multi-vessel treatment involving the right coronary artery (RCA) with aorto-ostial region. Methods: Four published studies provide the clinical effectiveness data for the PCI and CABG treatment groups. A decision analytic model in the form of a decision tree is used to estimate expected incremental cost-effectiveness ratio (ICER) at one- and two-year follow-up. The decision tree includes the following endpoints; all-cause death, any myocardial infarction (MI), any coronary artery revascularization, and successful treatment (absence of all-cause death, any coronary artery revascularization, and any MI. Financial experts provided information concerning the cost of the used resources in the Netherlands. Information concerning costs of the resources used in the US is obtained through literature. Results: Clinical effectiveness following a CABG index intervention is as good as, but in general more favourable, than PCI intervention. Expected cost (the direct medical cost of the index intervention and follow-up) for patients receiving CABG during the index intervention is higher. Conclusion: Of the three patient populations included in this cost-effectiveness analysis (CEA) the RCA with aorto-ostial coverage (AOC) patient population has the most favourable cost per additional successful treatment after one-year follow-up. When €80.000 is considered the upper limit for the willingness to pay (WTP) per additional successful treatment in the Netherlands, the RCA with AOC patient population, is the only patient population included in this cost-effectiveness analysis, where CABG is considered cost-effective over PCI.
Item Type:Essay
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:44 medicine
Programme:Health Sciences MSc (60022)
Link to this item:http://purl.utwente.nl/essays/66883
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