Percutaneous Coronary Intervention with Drug Eluting Stent versus Coronary Artery Bypass Surgery in Armenia: A Cost-Effectiveness Study

Abstract

Background: Although coronary artery bypass surgery (CABG) remains the treatment of choice for some types of coronary artery disease (CAD), percutaneous coronary intervention (PCI) specifically with drug-eluting stent (DES) has become the most popular nonmedical treatment method to CAD. The objective of the study was to compare cost-effectiveness of CABG versus PCI with DES among patients treated in the period from 2004 to 2005 years at Nork Marash Medical Center (NMMC) in Armenia. Methods: We did cost-effectiveness analysis from the perspective of patients treated in the single cardiac surgery center - NMMC. Contact, background and procedural information of patients was collected retrospectively from the medical records. Telephone survey was conducted for the evaluation of major adverse cardiac events (MACEs) and resource utilization. Patients who were more than 70 years old, who had prior revascularization (CABG or PCI), cardiogenic shock, end-stage renal disease (serum creatinine level>2 mg/dl), severe left ventricular dysfunction, or cancer at the time of admission were excluded from the sample. We also excluded patients whose procedures were covered by the Ministry of Health of Armenia and third party payers (TPP). NMMC price lists were used to calculate costs of utilized services. Results: The total number of patients was124 or 62 in each group. The adjusted difference in number of MACEs between CABG and PCI was -0.29 (95% CI: -0.49 -0.10). The adjusted difference in costs of CABG and PCI was $USD -1896.61 (95% CI: -2956.57 -836.63). The CABG was the dominant strategy. Conclusion: Based on the study results, the CABG is more cost-effective than the PCI having lower number of MACEs in terms of repeat revascularization (RR), myocardial infarction (MI) and death and offering lower costs.