Author + information
- Received April 16, 2014
- Revision received August 29, 2014
- Accepted September 3, 2014
- Published online January 6, 2015.
- Zugui Zhang, PhD∗∗ (, )
- Paul Kolm, PhD∗,
- Maria V. Grau-Sepulveda, MD, MPH†,
- Angelo Ponirakis, PhD‡,
- Sean M. O’Brien, PhD†,
- Lloyd W. Klein, MD§,
- Richard E. Shaw, PhD‖,
- Charles McKay, MD¶,
- David M. Shahian, MD#,
- Frederick L. Grover, MD∗∗,††,
- John E. Mayer, MD‡‡,
- Kirk N. Garratt, MD, MSc§§,
- Mark Hlatky, MD‖‖,
- Fred H. Edwards, MD¶¶ and
- William S. Weintraub, MD∗
- ∗Value Institute, Christiana Care Health System, Newark, Delaware
- †Department of Outcomes, Health Economics, and Quality of Life, Duke Clinical Research Institute, Durham, North Carolina
- ‡Department of Research Study, American College of Cardiology, Washington, DC
- §Section of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois
- ‖Department of Clinical Informatics, California Pacific Medical Center, San Francisco, California
- ¶Section of Cardiology, Harbor-UCLA Medical Center, Torrance, California
- #Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
- ∗∗Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
- ††Section of Cardiology, Denver Department of Veterans Affairs Medical Center, Denver, Colorado
- ‡‡Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
- §§Department of Interventional Cardiovascular Research, Lenox Hill Heart and Vascular Institute of New York, New York, New York
- ‖‖Department of Health Research and Policy, Stanford University, Palo Alto, California
- ¶¶Department of Surgery, University of Florida Shands Jacksonville, Jacksonville, Florida
- ↵∗Reprint requests and correspondence:
Dr. Zugui Zhang, Value Institute, Christiana Care Health System, 4755 Ogletown Stanton Road, Newark, Delaware 19718-2200.
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.
Objectives This study examined the cost-effectiveness of CABG versus PCI for stable ischemic heart disease.
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.
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.
Conclusions Over a period of 4 years or longer, patients undergoing CABG had better outcomes but at higher costs than those undergoing PCI.
- coronary artery bypass graft
- incremental cost-effectiveness ratio
- percutaneous coronary intervention
- stable ischemic heart disease
This work is supported by a grant from the National Heart, Lung, and Blood Institute (#RC2HL101489) and by an Institutional Development Award from the National Institute of General Medical Sciences (#U54-GM104941) of the National Institutes of Health. Dr. Grover consults for, but does not receive fees from, Somalution. Dr. Garratt consults for The Medicines Company and Boston Scientific Corporation; and receives research support from Boston Scientific Corporation, DSI/Lily, CeloNova, and the Mayo Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Steven Nissen, MD, served as Guest Editor for this paper.
- Received April 16, 2014.
- Revision received August 29, 2014.
- Accepted September 3, 2014.
- 2015 American College of Cardiology Foundation