CORONARY ARTERY DISEASE Original Studies Cost-Effectiveness of Percutaneous Coronary Intervention With Drug-Eluting Stents in Patients With Multivessel Coronary Artery Disease Compared to Coronary Artery Bypass Surgery Five-Years After Intervention

Objectives: Cost-effectiveness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES), and coronary artery bypass surgery (CABG) was analyzed in patients with multivessel coronary artery disease over a 5-year follow-up. Back-ground: DES implantation reducing revascularization rate and associated costs might be attractive for health economics as compared to CABG. Methods: Consecutive patients with multivessel DES-PCI (n5 114, 3.36 1.2 DES/patient) or CABG (n5 85, 2.760.9 grafts/patient) were included prospectively. Primary endpoint was cost-benefit of multivessel DES-PCI over CABG, and the incremental cost-effectiveness ratio (ICER) was calculated. Secondary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE), including acute myocardial infarction (AMI), all-cause death, revascularization, and stroke. Results: Despite multiple uses for DES, in-hospital costs were significantly less for PCI than CABG, with 4551 e/patient difference between the groups. At 5-years, the overall costs remained higher for CABG patients (mean difference 5400 e between groups). Cost-effectiveness planes including all patients or subgroups of elderly patients, diabetic patients, or Syntax score>32 indi-cated that CABG is a more effective, more costly treatment mode for multivessel dis-ease. At the 5-year follow-up, a higher incidence of MACCE (37.7 % vs. 25.8%; log ran