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Cost-effectiveness of revascularization strategies: the ASCERT study.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2015 Jan 06; Vol. 65 (1), pp. 1-11. - Publication Year :
- 2015
-
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.<br />Objectives: This study examined the cost-effectiveness of CABG versus PCI for stable ischemic heart disease.<br />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.<br />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.<br />Conclusions: Over a period of 4 years or longer, patients undergoing CABG had better outcomes but at higher costs than those undergoing PCI.<br /> (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Comparative Effectiveness Research
Cost of Illness
Cost-Benefit Analysis
Female
Hospitalization economics
Humans
Life Expectancy
Male
Medicare
Myocardial Ischemia economics
Propensity Score
Quality-Adjusted Life Years
United States
Coronary Artery Bypass economics
Myocardial Ischemia therapy
Percutaneous Coronary Intervention economics
Subjects
Details
- Language :
- English
- ISSN :
- 1558-3597
- Volume :
- 65
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 25572503
- Full Text :
- https://doi.org/10.1016/j.jacc.2014.09.078