| Autor: |
Little, M, Gray, A, Altman, DG, Benedetto, U, Flather, M, Gerry, S, Lees, B, Murphy, J, Gaudino, M, Taggart, D |
| Jazyk: |
angličtina |
| Rok vydání: |
2021 |
| Popis: |
Objectives: Using bilateral internal thoracic arteries (BITA) for coronary artery bypass grafting (CABG) has been suggested to improve survival compared to CABG using single internal thoracic arteries (SITA) for patients with advanced coronary artery disease. We used data from the Arterial Revascularisation Trial (ART) to assess long-term cost-effectiveness of BITA grafting compared to SITA grafting from an English health system perspective. Methods: Resource use, healthcare costs and quality-adjusted life-years (QALYs) were assessed across 10-years of follow-up. An intention-to-treat analysis of differences between trial arms was conducted. Missing data were addressed using multiple imputation. Incremental cost-effectiveness ratios were calculated with uncertainty characterised using non-parametric bootstrapping. Results were extrapolated beyond 10 years using Gompertz functions for survival and linear models for total cost and utility. Results: Total mean costs at 10 years of follow-up were estimated at £17,594736 in the BITA arm and £16,462594 in the SITA arm (mean difference £1,133118 95% CI £239195 to £2,026041, p= 0.01520). Total mean QALYs at 10 years were 6.54 in the BITA are and 6.57 in the SITA arm (adjusted mean difference -0.01 95% CI -0.2 to 0.1, p= 0.883). The estimated probability of BITA grafting being cost-effective compared to SITA grafting was 33% over 10 years of follow-up assuming a cost-effectiveness threshold of £20,000. Mean costs extrapolated to life-time increased to £20,760 in the SITA arm and £21,925 in the BITA arm. Mean QALYs extrapolated to life-time were 12.52 in the SITA arm and 12.61 in the BITA arm., The probability of BITA being cost-effective at a £20,000 threshold increased to 5160% when extrapolated to lifetime. Conclusions: BITA grafting has significantly higher costs but similar quality-adjusted survival at 10 years compared to SITA grafting. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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