CORONARY BYPASS SURGERY VERSUS PERCUTANEOUS CORONARY INTERVENTION: COST-EFFECTIVENESS IN IRAN: A STUDY IN PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE

Objectives: The aim of this study was to evaluate cost effectiveness of coronary artery bypass graft (CABG) versus percutaneous coronary intervention (PCI) with stenting from Iran society perspective. Methods: A retrospective study was carried out to estimate the annual cost and health related quality of life (HRQoL) of 109 patients who underwent coronary revascularization (PCI [n = 75] and CABG [n = 34]). A Markov model has been developed to determine the cost effectiveness of CABG compared with PCI. We used the model to calculate lifetime costs, life-years (LYs), and quality-adjusted life-years (QALYs) of each strategy. We also used probabilistic sensitivity analysis to test model robustness. Results: We found that discounted QALY lived per person in CABG versus PCI group in 5 years, 10 years, and lifetime time horizon were (3.8 +/- 0.13 versus 3.88 +/- 0.14), (6.4 +/- 0.23 versus 6.33 +/- 0.22), and (8.74 +/- 0.29 versus 8.33 +/- 0.27), respectively. The estimated medical cost of CABG and PCI per patient in 5 years, 10 years, and lifetime time horizon were (USD 6,819 +/- 765 versus 9,011 +/- 1,816), (USD 8,852 +/- 1,348 versus 12,034 +/- 2,375), and (USD 14,037 +/- 4,201 versus 18,798 +/- 5,821), respectively. The incremental cost-effectiveness ratio results showed CABG is a dominate alternative in 10 years and lifetime time horizon. Conclusions: This study demonstrated that despite higher initial cost and lower HRQoL, CABG is a cost-effective revascularization strategy compared with PCI for patients with multivessel coronary artery disease in long-term.