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Economic outcomes and quality of life after CABG or PCI for multivessel disease: The FAME 3 Trial.

Economic outcomes and quality of life after CABG or PCI for multivessel disease: The FAME 3 Trial. Journal of the American College of Cardiology Hlatky, M. A., Ding, V. Y., Zimmermann, F. M., Piroth, Z., Davidavicius, G., Mansour, S., Kharbanda, R., Jokhaji, F., Oldroyd, K. G., Wendler, O., Reardon, M. J., Sreckovic, M., Yeung, A. C., Pijls, N. H., De Bruyne, B., Desai, M., Fearon, W. F., FAME 3 Investigators 2025

Abstract

BACKGROUND: Previous studies have found coronary artery bypass grafting (CABG) to be cost-effective compared with percutaneous coronary intervention (PCI) among patients with multivessel coronary artery disease (CAD), but their comparative effectiveness and economic outcomes may have changed.OBJECTIVES: We sought to compare the economic and quality of life outcomes of CABG versus PCI and determine their cost-effectiveness in the Fractional Flow Reserve (FFR) versus Angiography for Multivessel Evaluation (FAME) 3 randomized trial.METHODS: FAME 3 randomly assigned 1500 patients with three-vessel CAD to either CABG or FFR-guided PCI using zotarolimus drug-eluting stents (DES). We documented resource use and quality of life over five years of follow-up. We calculated costs by applying Medicare reimbursement rates to resources used, assessed quality of life using the EuroQOL EQ-5D, calculated quality-adjusted life-years (QALYs) from EQ-5D utility values, and used multivariable regression to compare outcomes by treatment assignment. We calculated the incremental cost-effectiveness ratio (ICER) based on five-year outcomes and also on projected life expectancies, and assessed its variability in 10,000 bootstrap replications.RESULTS: Cumulative costs over five years were 30% higher in patients assigned to CABG (95% confidence interval [CI], 16% to 46%, P<0.001). QALYs over five years did not differ significantly between the PCI (4.05±0.84) and CABG groups (4.03±0.82), although EQ-5D scores improved more rapidly after PCI. Patients < 65 years of age at enrollment assigned to PCI were more likely to be employed at five years (56% vs 47%, p=0.025). PCI had greater economic value than CABG over five years, with lower costs and higher QALYs in 66% of replications, and ICERs for CABG above the $150,000/QALY benchmark in 98% of bootstrap replications. These findings were essentially unchanged in several lifetime projections based on the outcomes documented within the trial follow-up period.CONCLUSIONS: FFR-guided PCI using zotarolimus DES provides significantly better long-term value than CABG for treatment of patients with multivessel CAD, with equivalent clinical outcomes at substantially lower cost.

View details for DOI 10.1016/j.jacc.2025.10.017

View details for PubMedID 41194756