Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Medicine in Ischemic Cardiomyopathy: The STICH Randomized Clinical Trial

Derek S. Chew, Patricia A. Cowper, Hussein Al-Khalidi, Kevin J. Anstrom, Melanie R. Daniels, Linda Davidson-Ray, Yanhong Li, Robert E. Michler, Julio A. Panza, Ileana L. Pina, Jean L. Rouleau, Eric J. Velazquez, Daniel B. Mark

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure) demonstrated that coronary artery bypass grafting (CABG) reduced all-cause mortality rates out to 10 years compared with medical therapy alone (MED) in patients with ischemic cardiomyopathy and reduced left ventricular function (ejection fraction ≤35%). We examined the economic implications of these results. Methods: We used a decision-analytic patient-level simulation model to estimate the lifetime costs and benefits of CABG and MED using patient-level resource use and clinical data collected in the STICH trial. Patient-level costs were calculated by applying externally derived US cost weights to resource use counts during trial follow-up. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective. Results: For the CABG arm, we estimated 6.53 quality-adjusted life-years (95% CI, 5.70-7.53) and a lifetime cost of $140 059 (95% CI, $106 401 to $180 992). For the MED arm, the corresponding estimates were 5.52 (95% CI, 5.06-6.09) quality-adjusted life-years and $74 894 lifetime cost (95% CI, $58 372 to $93 541). The incremental cost-effectiveness ratio for CABG compared with MED was $63 989 per quality-adjusted life-year gained. At a societal willingness-to-pay threshold of $100 000 per quality-adjusted life-year gained, CABG was found to be economically favorable compared with MED in 87% of microsimulations. Conclusions: In the STICH trial, in patients with ischemic cardiomyopathy and reduced left ventricular function, CABG was economically attractive relative to MED at current benchmarks for value in the United States. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00023595.

Original languageEnglish (US)
Pages (from-to)819-828
Number of pages10
JournalCirculation
Volume145
Issue number11
DOIs
StatePublished - Mar 15 2022

Keywords

  • cardiomyopathies
  • coronary artery bypass
  • coronary artery disease
  • cost-benefit analysis
  • costs and cost analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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