Angina: bypass surgery was no more cost-effective than angioplasty.

Clinical bottom line (level 2b)

  1. In patients with severe angina or myocardial ischaemia, coronary bypass surgery was not clearly more cost-effective than coronary angioplasty.
  2. Patients who had angioplasty returned to work sooner than those who had bypass surgery (~5 weeks).
Hlatky et al: New England Journal of Medicine 1997; 336 (2): 92-99
Expires February 2003

The study

cost-effectiveness study
Setting: seven centres, USA.

Patients were from the Bypass Angioplasty Revascularization Investigation (BARI) trial. Patients had angina or objective evidence of myocardial ischaemia severe enough to warrant coronary revascularisation, stenosis of 50% or more in two or more coronary vessels, technical suitability for both angioplasty and bypass surgery, and no prior coronary revascularisation procedure. They were randomised to coronary angioplasty of coronary bypass surgery.

  • Viewpoint: third party, eg. HMO
  • Benefit assessment: quality of life
  • Resources and costs: Hospital bills were obtained for all discharges after randomisation. Charges from each hospital were converted to costs by multiplying the charges by the department-specific ratio of costs to charges as found in each hospital's Medicare cost report. All costs were adjusted to 1995 dollars and discounted at a rate of 3% per year.
  • Sensitivity analysis: Variability of cost, interaction between the number of diseased vessels and the assigned treatment

    • The evidence

    intervention cost
    bypass surgery $58,889
    ( 4.4 life years added )
    angioplasty $56,225
    ( 4.3 life years added )

    • Patients in the angioplasty group returned to work sooner than those in the bypass group (median 6 vs 11 weeks).
    • Surgery group included 469 patients compared to 465 in angioplasty group.

    Citation

    1. Hlatky MA, Rogers WJ, Johnstone I, et al: Medical care costs and quality of life after randomization to coronary angioplasty or coronary bypass surgery. New England Journal of Medicine 1997; 336 (2): 92-99
    Contributor: Clare Wotton, February 2001
    Reviewer: Musab Hayatli

    Clinical Question.
    Patient angina or ischaemia severe enough to warrant revascularisation
    Intervention or Exposure coronary angioplasty
    Comparison coronary bypass surgery
    Outcome cost-effectiveness