Cost-effectiveness of on-pump and off-pump coronary artery bypass grafting for patients with coronary artery disease: Results from the MASS III trial INTERNATIONAL JOURNAL OF CARDIOLOGY Scudeler, T., Hueb, W. A., Farkouh, M. E., Maron, D. J., de Soarez, P., Campolina, A., Takiuti, M., Rezende, P., Godoy, L., Hueb, A., Lima, E., Garzillo, C., Franchini Ramires, J., Kalil Filho, R. 2018; 273: 63–68


Recent trials have reported similar clinical outcomes between on-pump and off-pump coronary artery bypass graft (CABG). However, long-term cost-effectiveness of these strategies is unknown.A prespecified economic study was performed based on the MASS III trial. Costs were estimated for all patients based on observed healthcare resource usage over a 5-year follow-up. Health state utilities were evaluated with the SF-6D questionnaire. Cost-effectiveness was assessed as cost per quality-adjusted life-year (QALY) gained using a Markov model. Probabilistic sensitivity analysis with the Monte-Carlo simulation and cost-effectiveness acceptability curve were used to address uncertainty.Quality of life improved significantly in both groups during follow-up compared with baseline. At 5?years, when comparing on-pump and off-pump CABG groups, no differences were found in cumulative life-years (4.851 and 4.766?years, P?=?.319) and QALY gained (4.150 and 4.105 QALYs, P?=?.332). Mean cost in US dollars per patient during the trial did not differ significantly between the on-pump and off-pump groups ($5890.29 and $5674.75, respectively, P?=?.409). Over a lifetime horizon, the incremental cost-effectiveness ratio of on-pump versus off-pump CABG was $12,576 per QALY gained, which is above the suggested cost-effectiveness threshold range (from $3210 to 10,122). In the sensitivity analysis, the probability that on-pump CABG is cost-effective compared to off-pump surgery for a willingness-to-pay threshold of $3212 per QALY gained was <1%. For the $10,122 per QALY threshold, the same probability was 35%.This decision-analytic model suggests that on-pump CABG is not cost-effective when compared to off-pump CABG from a public health system perspective.

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