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Study Finds Angioplasty More Cost-Effective than Bypass Surgery
 A study involving hundreds of high-risk heart patients at 16 Veterans Affairs medical centers found that balloon angioplasty was less costly than heart bypass surgery, but just as likely to keep patients alive. The findings appeared Sept. 16, 2006 in Circulation, a journal of the American Heart Association, and were reported on in Forbes, the Washington Post, and other news outlets.
The 445 veterans in the study—almost all men, most in their late 60s—had severe blockages or narrowing of the arteries carrying blood to the heart. Many had just suffered a heart attack or were at high risk for one, or had serious signs of heart failure. They were randomly assigned to percutaneous coronary intervention (PCI)—also known as angioplasty—or coronary artery bypass graft (CABG) surgery. Both are well-established treatments, but questions have remained over their relative cost-effectiveness.
Over three years of follow-up, total medical costs for the PCI group averaged $63,896 per patient, compared with $84,364 in the CABG group. After five years, costs were $81,790 in the PCI group versus $100,522 for CABG. The five-year survival rate was 75 percent for PCI and 70 percent for CABG, although this difference in favor of PCI was not statistically significant.
"Angioplasty maintains a significant cost advantage with no adverse impact on survival rates, even after five years," said lead author Kevin T. Stroupe, PhD, a health economist at the Hines, Ill., VA Medical Center.
Compared with CABG patients, PCI patients were more likely to need repeat procedures over the years to clear blocked arteries, but the overall PCI costs still remained lower. And, according to previously published results from the same trial, the quality of life remained roughly the same between the two groups over the follow-up period.
The initial procedures in the study were performed during the period from 1995 to 2000, when cardiologists were just starting to use stents for angioplasty. In the basic procedure, doctors insert a balloon-tipped catheter into the narrowed or blocked artery. The balloon is then inflated to open the artery. Stents are wire-mesh tubes that fit over the balloon tip and remain in place after the balloon is deflated and removed, thus helping to keep open the newly cleared artery.
In more recent years, doctors have added yet another twist to the procedure: Most angioplasties, in VA and elsewhere, now use stents coated with a polymer that releases a drug to prevent the formation of scar tissue, which could cause the artery to again become blocked.
According to Stroupe and his coauthors, these developments in medical technology, while adding slightly to initial PCI costs, are unlikely to affect the conclusions of their cost-effectiveness analysis.
Coronary revascularization—opening or bypassing blocked arteries leading to the heart—is among the most frequently performed medical procedures in the United States, and accounts for between $12 billion and $20 billion in healthcare costs each year. Stroupe said that in 2002, U.S. doctors performed some 1.2 million angioplasties and 306,000 coronary artery bypass grafts.
The study by Stroupe and colleagues, dubbed the AWESOME trial (for "Angina with Extremely Serious Operative Mortality Evaluation"), was funded by VA's Cooperative Studies Program (CSP study #385) and the National Institutes of Health. Collaborating on the research were investigators and clinicians from several VA facilities, as well as the following academic sites: Northwestern University, the University of Arizona, Stanford University, Loyola University, and the University of Colorado.
Additional Information
Stroupe KT, Morrison DA, Hlatky MA, et al. Cost-effectiveness of coronary artery bypass grafts versus percutaneous coronary intervention for revascularization of high-risk patients. Circulation 2006; 114: 1251-1257.
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