In comparison to medical therapy alone (MED) in patients with ischemic cardiomyopathy and decreased left ventricular function (ejection fraction ≤35%), the STICH (Surgical Treatment for Ischemic Heart Failure) Randomized Clinical Trial exhibited that all-cause mortality rates were decreased to 10 years by coronary artery bypass grafting (CABG). The researchers explored the financial aspects of these outcomes. To estimate the lifetime expenditure and advantages of CABG and MED, the researchers utilized the patient-level resource use and clinical data accumulated from the STICH trial. They made the estimation using a decision-analytic patient-level simulation model. During trial follow-up, they applied externally derived US cost weights to resource use counts and used them to calculate the patient-level costs. They also applied a 3% discount to both future expenditure and advantages. The main result was the incremental cost-effectiveness, which they examined from the perspective of the US health care sector.
The researchers gauged 6.53 quality-adjusted life-years (95% CI, 5.70–7.53) and a lifetime expense of $140,059 (95% CI, $106,401 to $180,992) for the CABG. In contrast, it was 5.52 (95% CI, 5.06–6.09) quality-adjusted life-years and $74,894 lifetime cost (95% CI, $58,372 to $93,541) for MED. In comparison to MED, CABG’s incremental cost-effectiveness ratio was $63,989 per quality-adjusted life-year gained. The researchers discovered that CABG received preference over MED in 87% of microsimulations from a financial perspective because the societal willingness-to-pay threshold was $100,000 per quality-adjusted life-year gained. At the present benchmarks for value in the US, the researchers concluded that patients with ischemic cardiomyopathy and reduced left ventricular function preferred CABG because it was financially lucrative.
Link:www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056276
