Conference Coverage

FREEDOM: CABG Shows Excellent Cost Effectiveness



LOS ANGELES – Coronary artery bypass graft surgery not only provides better clinical outcomes than percutaneous coronary intervention in diabetic patients with multivessel disease, but it does so in a highly cost-effective manner, according to an economic analysis of the FREEDOM trial.

"The benefits are achieved at an overall cost that represents an attractive use of societal health care resources," Elizabeth A. Magnuson, Sc.D., said at the annual scientific sessions of the American Heart Association.

Dr. Elizabeth A. Magnuson

FREEDOM was a randomized international trial that compared the effectiveness of CABG with percutaneous coronary intervention (PCI) using drug-eluting stents in 1,900 diabetic patients with multivessel coronary artery disease who were candidates for both procedures.

The initial hospitalization for revascularization cost an average of $34,467 in the CABG group, $8,622 more than for PCI-treated patients. But during the next 5 years of follow-up, both repeat revascularizations and mortality were significantly more common in the PCI group.

Based on a conservative model of projected survival that assumed a gradual attenuation of CABG’s clinical benefits over time, bypass surgery was associated with an incremental cost-effectiveness ratio of $8,132 per quality-adjusted year of life (QALY) gained. That’s well below the figure of $50,000 per QALY widely accepted by health policy makers as defining the upper boundary of cost effectiveness, noted Dr. Magnuson, director of health economics and technology assessment at Saint Luke’s Mid-America Heart Institute, Kansas City, Mo.

Dr. Mark A. Hlatky

"Even if we assume no further benefit beyond the trial period and we just captured the life-years lost due to the in-trial death events, we still get very favorable results for CABG, with an incremental cost-effectiveness ratio of roughly $27,000 per QALY," she said.

Discussant Dr. Mark A. Hlatky agreed with Dr. Magnuson that this was a very conservative analysis and said that the actual cost effectiveness of CABG in diabetes patients with multivessel disease might well be even more favorable than she projected.

"The cost-effectiveness results are quite good. This looks like a very economically attractive therapy for patients who have diabetes with multivessel disease," concluded Dr. Hlatky, professor of health research and policy and of cardiovascular medicine at Stanford (Calif.) University.

The study was funded by the National Heart, Lung, and Blood Institute. Dr. Magnuson and Dr. Hlatky reported having no relevant financial conflicts.

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