Key result
Current cost-effectiveness evidence does not support the increased use of percutaneous coronary intervention, as optimal medical therapy or coronary artery bypass grafting were found to be more cost-effective in most scenarios.
Why the study?
Is PCI, CABG, or medical therapy the most cost-effective treatment for coronary artery disease?
Systematic Review (n=5)
Is PCI, CABG, or medical therapy the most cost-effective treatment for coronary artery disease?
Current cost-effectiveness evidence does not support the increased use of PCI for coronary artery disease, with medical therapy and CABG generally found to be more cost-effective.
<ns4:p> <ns4:bold>Background</ns4:bold> : Cardiovascular disease remains the primary cause of death among Australians, despite dramatic improvements in overall cardiovascular health since the 1980s. Treating cardiovascular disease continues to place a significant economic strain on the Australian health care system, with direct healthcare costs exceeding those of any other disease. Coronary artery disease accounts for nearly one third of these costs and spending continues to rise. </ns4:p> <ns4:p>A range of treatments is available for coronary artery disease yet evidence of cost-effectiveness is missing, particularly for the Australian context. Cost-effectiveness evidence can signal waste and inefficiency and so is essential for an efficient allocation of healthcare resources.</ns4:p> <ns4:p> <ns4:bold>Methods:</ns4:bold> We used systematic review methods to search the literature across several electronic databases for economic evaluations of treatments for coronary artery disease. We critically appraised the literature found in searches, both against the CHEERS statement for quality reporting of economic evaluations and in terms of its usefulness for policy and decision-makers. </ns4:p> <ns4:p> <ns4:bold>Results:</ns4:bold> We retrieved a total of 308 references, 229 once duplicates were removed. Of these, 26 were excluded as they were not full papers (letters, editorials etc.), 55 were review papers, 50 were not cost-effectiveness analyses and 93 related to a highly specific patient sub-group or did not consider all treatment options. This left five papers to be reviewed in full. </ns4:p> <ns4:p> <ns4:bold>Conclusions:</ns4:bold> The current cost-effectiveness evidence does not support the increased use of PCI that has been seen in Australia and internationally. Due to problems with accessibility, clarity and relevance to policy and decision-makers, some otherwise very scientifically rigorous analyses have failed to generate any policy changes. </ns4:p>
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McCreanor et al. (2018) conducted a systematic review in Coronary artery disease (n=5). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) and medical therapy was evaluated on Cost-effectiveness. Current cost-effectiveness evidence does not support the increased use of percutaneous coronary intervention, as optimal medical therapy or coronary artery bypass grafting were found to be more cost-effective in most scenarios.
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