Cost-effectiveness of bilateral vs. single internal thoracic artery grafts at 10 years

Little, Matthew, Gray, Alastair M., Altman, Douglas G., Benedetto, Umberto, Flather, Marcus, Gerry, Stephen, Lees, Belinda, Murphy, Jacqueline, Gaudino, Mario and Taggart, David P. and Arterial Revascularization Trial investigators (2022) Cost-effectiveness of bilateral vs. single internal thoracic artery grafts at 10 years. European Heart Journal - Quality of Care and Clinical Outcomes, 8 (3). 324–332. ISSN 2058-5225

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AIMS: Using bilateral internal thoracic arteries (BITAs) for coronary artery bypass grafting (CABG) has been suggested to improve survival compared to CABG using single internal thoracic arteries (SITAs) for patients with advanced coronary artery disease. We used data from the Arterial Revascularization Trial (ART) to assess long-term cost-effectiveness of BITA grafting compared to SITA grafting from an English health system perspective. METHODS AND RESULTS: Resource use, healthcare costs, and quality-adjusted life years (QALYs) were assessed across 10 years of follow-up from an intention-to-treat perspective. Missing data were addressed using multiple imputation. Incremental cost-effectiveness ratios were calculated with uncertainty characterized using non-parametric bootstrapping. Results were extrapolated beyond 10 years using Gompertz functions for survival and linear models for total cost and utility. Total mean costs at 10 years of follow-up were £17 594 in the BITA arm and £16 462 in the SITA arm [mean difference £1133 95% confidence interval (CI) £239 to £2026, P = 0.015]. Total mean QALYs at 10 years were 6.54 in the BITA arm and 6.57 in the SITA arm (adjusted mean difference -0.01 95% CI -0.2 to 0.1, P = 0.883). At 10 years, BITA grafting had a 33% probability of being cost-effective compared to SITA, assuming a cost-effectiveness threshold of £20 000. Lifetime extrapolation increased the probability of BITA being cost-effective to 51%. CONCLUSIONS: BITA grafting has significantly higher costs but similar quality-adjusted survival at 10 years compared to SITA grafting. Extrapolation suggests this could change over lifetime.

Item Type: Article
Additional Information: Funding: This work was supported by the British Heart Foundation, London (SP/03/001), the UK Medical Research Council, London (G0200390), and the National Institute of Health Research Efficacy and Mechanism Evaluation Programme, Southampton (09/800/29). A.M.G. is partly funded by the NIHR Biomedical Research Centre, Oxford, UK.
Uncontrolled Keywords: bypass,coronary artery disease,coronary artery disease surgery,healthcare economics,revascularization,health policy,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2719
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit
Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 03 Feb 2021 01:00
Last Modified: 03 Nov 2022 16:33
DOI: 10.1093/ehjqcco/qcab004


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