Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Medicine in Ischemic Cardiomyopathy: The STICH Randomized Clinical Trial. Issue 11 (19th January 2022)

• Record Type: Journal Article
• Authors: Chew, Derek S.; Cowper, Patricia A.; Al-Khalidi, Hussein; Anstrom, Kevin J.; Daniels, Melanie R.; Davidson-Ray, Linda; Li, Yanhong; Michler, Robert E.; Panza, Julio A.; Piña, Ileana L.; Rouleau, Jean L.; Velazquez, Eric J.; Mark, Daniel B.
• Is Part Of: Circulation. Volume 145:Issue 11(2022)
• Page Start: 819
• Page End: 828
• Publication Date: 2022-01-19
• Subjects: cardiomyopathies -- coronary artery bypass -- coronary artery disease -- cost-benefit analysis -- costs and cost analysis; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.121.056276
• Languages: English
• ISSNs: 0009-7322

Abstract

Abstract : Background: The STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure) demonstrated that coronary artery bypass grafting (CABG) reduced all-cause mortality rates out to 10 years compared with medical therapy alone (MED) in patients with ischemic cardiomyopathy and reduced left ventricular function (ejection fraction ≤35%). We examined the economic implications of these results. Methods: We used a decision-analytic patient-level simulation model to estimate the lifetime costs and benefits of CABG and MED using patient-level resource use and clinical data collected in the STICH trial. Patient-level costs were calculated by applying externally derived US cost weights to resource use counts during trial follow-up. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective. Results: For the CABG arm, we estimated 6.53 quality-adjusted life-years (95% CI, 5.70–7.53) and a lifetime cost of $140 059 (95% CI, $106 401 to $180 992). For the MED arm, the corresponding estimates were 5.52 (95% CI, 5.06–6.09) quality-adjusted life-years and $74 894 lifetime cost (95% CI, $58 372 to $93 541). The incremental cost-effectiveness ratio for CABG compared with MED was $63 989 per quality-adjusted life-year gained. At a societal willingness-to-pay threshold of $100 000 per quality-adjusted life-year gained, CABG was found to be economically favorable compared with MED in 87% of microsimulations. Conclusions: In the STICH trial, in patients with ischemic cardiomyopathy and reduced left ventricular function, CABG was economically attractive relative to MED at current benchmarks for value in the United States. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00023595.