PharmacoEconomics & Outcomes News 595 - 23 Jan 2010

High costs of revascularisationdifficult to recoup

In patients with type 2 diabetes mellitus and stablecoronary disease, prompt coronary revascularisationsignificantly increases costs. A strategy of medicaltherapy (with delayed revascularisation as needed)appears to be more cost effective, at least over the shortterm.

Data from the Bypass Angioplasty RevascularisationInvestigation 2 Diabetes (BARI 2D) trial show that overfour years of follow-up, the high initial procedural costsassociated with coronary artery bypass grafts (CABGs)and percutaneous coronary interventions (PCIs) wereonly partially offset by later savings in costs formedications and cardiovascular testing.

In patients stratified to CABG, promptrevascularisation was associated with significantlyhigher costs and yet it provided fewer life-years ofsurvival than medical therapy. However, whenprojected over a lifetime, CABG yielded a favourablecost-effectiveness ratio of $47 000 per life-year gained.A probabilistic sensitivity analysis showed that CABGwas the preferred option in 56% of bootstrapreplications.

In patients stratified to PCI, revascularisation wasassociated with higher costs than medical therapy andfewer life-years of survival over the 4-year follow-up.When projected over a lifetime, medical therapy costswere actually slightly higher than the costs associatedwith prompt revascularisation; however, medicaltherapy was still associated with greater life-years ofsurvival. Medical therapy was preferred overrevascularisation in 95% of bootstrap replications.Hlatky MA, et al. Economic Outcomes of Treatment Strategies for Type 2Diabetes Mellitus and Coronary Artery Disease in the Bypass AngioplastyRevascularization Investigation 2 Diabetes Trial. Circulation 120: 2550-2558, No.25, 22 Dec 2009. Available from: URL: http://dx.doi.org/10.1161/CIRCULATIONAHA.109.912709 803004221

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PharmacoEconomics & Outcomes News 23 Jan 2010 No. 5951173-5503/10/0595-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved