One year comparison of costs of coronary surgery versus percutaneous coronary intervention in the stent or surgery trial

Abstract

Objectives: To compare initial and one year costs of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in the stent or surgery trial.

Design: Prospective, unblinded, randomised trial.

Setting: Multicentre study.

Patients: 988 patients with multivessel disease.

Interventions: CABG and stent assisted PCI.

Main outcome measures: Initial hospitalisation and one year follow up costs.

Results: At one year mortality was 2.5% in the PCI arm and 0.8% in the CABG arm (p = 0.05). There was no difference in the composite of death or Q wave myocardial infarction (6.9% for PCI v 8.1% for CABG, p = 0.49). There were more repeat revascularisations with PCI (17.2% v 4.2% for CABG). There was no significant difference in utility between arms at six months or at one year. Quality adjusted life years were similar 0.6938 for PCI v 0.6954 for PCI, Delta = 0.00154, 95% confidence interval (CI) -0.0242 to 0.0273). Initial length of stay was longer with CABG (12.2 v 5.4 days with PCI, p < 0.0001) and initial hospitalisation costs were higher (7321 pounds sterling v 3884 pounds sterling for PCI, Delta = 3437 pounds sterling, 95% CI 3040 pounds sterling to 3848 pounds sterling). At one year the cost difference narrowed but costs remained higher for CABG (8905 pounds sterling v 6296 pounds sterling for PCI, Delta = 2609 pounds sterling, 95% CI 1769 pounds sterling to 3314 pounds sterling).

Conclusions: Over one year, CABG was more expensive and offered greater survival than PCI but little added benefit in terms of quality adjusted life years. The additional cost of CABG can be justified only if it offers continuing benefit at no further increase in cost relative to PCI over several years.

Figure 1

Initial hospitalisation costs for the percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) arms in major subgroups. ACS, acute coronary syndromes; CI, confidence interval; PMI, previous myocardial infarction.

Figure 2

Total one year costs for the PCI and CABG arms in major subgroups.