Which is more cost-effective — angioplasty or bypass surgery?
Hlatky MA, Rogers WJ, Johnstone I, et al. Medical care costs and quality of life after randomization to coronary angioplasty or coronary bypass surgery. N Engl J Med 1997; 336:92-99.
This randomized trial of patients receiving coronary angioplasty or coronary bypass surgery compared the quality of life, employment, and medical care costs of patients receiving either procedure after five years. Of the 934 patients studied, patients were given a functional-status score indicating their ability to perform common activities of daily living after the first three years of follow-up. Those scores improved more in patients who received surgery than in patients who received angioplasty (p < 0.05).
However, other quality-of-life measures improved equally in both groups. In addition, patients who received angioplasty returned to work five weeks sooner than patients who underwent surgery. The initial mean cost of angioplasty also was 65% less ($21,113 vs. $32,347) than for surgery, but after five years, the total medical cost of angioplasty was 95% that of surgery ($56,225 vs. $58,889, respectively).
In addition, the five-year cost of angioplasty was significantly lower than that of surgery among patients who had surgery on two coronary vessels ($52,930 vs. $58,498). But in patients with three-vessel disease, the five-year cost of angioplasty was higher $60,918 vs. $59,430.
After five years of follow-up, surgery had an overall cost-effectiveness ratio of $26,117 per year of life added, and surgery was especially cost-effective for patients with diabetes, who had significantly improved survival compared with diabetics receiving angioplasty.
"In patients with multivessel coronary disease, coronary artery bypass surgery is associated with a better quality of life for three years than coronary angioplasty, after the initial morbidity caused by the procedure," the researchers conclude. "Coronary angioplasty has a lower five-year cost than bypass surgery only in patients with two-vessel coronary disease."
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