Coronary artery bypass grafting was economically attractive compared with medical therapy in ischemic cardiomyopathy, with an incremental cost-effectiveness ratio of $63,989 per QALY gained.
RCT
Is coronary artery bypass grafting cost-effective compared to medical therapy alone in patients with ischemic cardiomyopathy and reduced left ventricular function?
In patients with ischemic cardiomyopathy and LVEF ≤35%, CABG is economically favorable compared to medical therapy alone at a $100,000/QALY threshold in the US.
Effect estimate: $63,989 per quality-adjusted life-year gained
BACKGROUND: The STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure) demonstrated that coronary artery bypass grafting (CABG) reduced all-cause mortality rates out to 10 years compared with medical therapy alone (MED) in patients with ischemic cardiomyopathy and reduced left ventricular function (ejection fraction ≤35%). We examined the economic implications of these results. METHODS: We used a decision-analytic patient-level simulation model to estimate the lifetime costs and benefits of CABG and MED using patient-level resource use and clinical data collected in the STICH trial. Patient-level costs were calculated by applying externally derived US cost weights to resource use counts during trial follow-up. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective. RESULTS: For the CABG arm, we estimated 6. 53 quality-adjusted life-years (95% CI, 5. 70-7. 53) and a lifetime cost of 140 059 (95% CI, 106 401 to 180 992). For the MED arm, the corresponding estimates were 5. 52 (95% CI, 5. 06-6. 09) quality-adjusted life-years and 74 894 lifetime cost (95% CI, 58 372 to 93 541). The incremental cost-effectiveness ratio for CABG compared with MED was 63 989 per quality-adjusted life-year gained. At a societal willingness-to-pay threshold of 100 000 per quality-adjusted life-year gained, CABG was found to be economically favorable compared with MED in 87% of microsimulations. CONCLUSIONS: In the STICH trial, in patients with ischemic cardiomyopathy and reduced left ventricular function, CABG was economically attractive relative to MED at current benchmarks for value in the United States. REGISTRATION: URL: https: //www. CLINICALTRIALS: gov; Unique identifier: NCT00023595.
A 2022 study conducted an RCT in Ischemic cardiomyopathy and reduced left ventricular function. Coronary artery bypass grafting (CABG) vs. Medical therapy alone (MED) was evaluated on Incremental cost-effectiveness ratio assessed from the US health care sector perspective ($63,989 per quality-adjusted life-year gained). Coronary artery bypass grafting was economically attractive compared with medical therapy in ischemic cardiomyopathy, with an incremental cost-effectiveness ratio of $63,989 per QALY gained.