In 5-year analysis, PCI wins over CABG for cost but not outcomes

Some things don’t make decisions easier: PCI may be more cost-effective, but CABG has fewer long-term major adverse events, according to a study published in the Dec. 1 issue of Catheterization and Cardiovascular Interventions.

The Austrian study followed 199 consecutive patients with multivessel disease through five years post-treatment with either PCI or CABG and angioplasty. Lisa Krenn, MD, of the cardiology department at Medical University of Vienna, and colleagues sought to understand differences in long-term costs and outcomes between the two procedures.

They found that while PCI cost less, both in the initial procedure and over five years, CABG patients experienced lower rates of major adverse cardiac and cerebrovascular events and fewer acute MI, strokes, or death. This translated to a major adverse events rate of 25.8 percent and 37.7 percent for CABG and PCI, respectively. Meanwhile rates of acute MI, stroke and death were 21.2 percent and 25.4 percent for CABG and PCI, respectively, over the five-year span.

The mean difference in hospital costs between PCI and CABG was $5,666 [4,551 €] per patient. At five years, overall costs played out to a difference of $6,723 [5,400 €] per patient.

Krenn et al wrote that 8.4 more CABG procedures per year instead of PCIs would result in one additional case of major-adverse-event-free survival. The incremental cost for this was calculated at an additional $56,795 [45,615 €] per additional major-adverse-event-free patient treated with CABG as opposed to PCI. However, acute MI, stroke, and death endpoints would require 23.5 more CABG patients over PCI to have one event-free patient, with an additional cost per patient of $157,734 [126,683 €].

This made use of CABG for both endpoints only feasible if the willingness to pay were high. When estimated at over $99,000 [80,000 €], only the major adverse event-free survival was worth the cost. At half that, CABG was not cost-effective for either endpoint.

Part of the reason for the increased cost, Krenn et al noted, was longer hospitalization times and blood transfusions in treating CABG patients, which did not balance the frequency of adverse events among PCI patients.

They wrote their findings were comparable to those in other studies.