Economics of coronary artery bypass grafting

Abstract

To decide whether the number of operations for coronary artery bypass grafting should be increased, maintained at the present levels, or decreased we need to know how cost effective they are relative to other claimants on the resources of the National Health Service. For this purpose effectiveness is taken to be the effect on life expectancy adjusted for the quality of life. In an assessment of the cost per quality adjusted life year gained coronary artery bypass grafting rates well for cases of severe angina and extensive coronary artery disease. The cost, however, rises sharply for less severe cases. Bypass grafting seems to compare favourably with valve replacement for aortic stenosis and implantation of pacemakers for heart block; it is distinctly better than heart transplantation and the treatment of end stage renal failure but is probably less cost effective than hip replacement. If the number of operations for coronary artery bypass grafting were to increase it would be a fairly strong claimant only if restricted to the most severe cases. The data on which these judgments are based are crude and in need of refinement. The methodology is powerful, far reaching, and open to comment.

KIE: To decide whether the rate of coronary artery bypass surgery in Great Britain should be increased, maintained at present levels, or decreased, the costs and benefits of this operation were evaluated and compared to the cost effectiveness of other expensive procedures provided by the National Health Service (NHS). Bypass grafting for more severe cases compares favorably with valve replacement for aortic stenosis and pacemaker implantation for heart block. It is more cost effective than heart transplantation and treatment for end stage renal failure, and probably less cost effective than hip replacement. The author concludes that, before any decision is reached, reliable comparisons must be made with other potential uses of NHS resources based on further research focused more on quality of life and public and private costs than on rate of survival.