Comparative cost-effectiveness of surgery, angioplasty, or medical therapy in patients with multivessel coronary artery disease: MASS II trial

Brandão, Sara Michelly Gonçalves; Rezende, Paulo Cury; Rocca, Hans-Peter Brunner-La; Ju, Yang Ting; de Lima, Antonio Carlos Pedroso; Takiuti, Myrthes Emy; Hueb, Whady; Bocchi, Edimar Alcides

doi:10.1186/s12962-018-0158-z

Cost Effectiveness and Resource Allocation

Table 3 Follow-up events, procedural resource use, and cost

From: Comparative cost-effectiveness of surgery, angioplasty, or medical therapy in patients with multivessel coronary artery disease: MASS II trial

	Year 1			Year 2			Year 3
	PCI (n = 195)	MT (n = 201)	CABG (n = 195)	PCI (n = 191)	MT (n = 197)	CABG (n = 191)	PCI (n = 189)	MT (n = 189)	CABG (n = 185)
Clinical outcomes, n (%)
Death	4 (2.1)	4 (2.0)	4 (2.1)	2 (1.0)	8 (4.1)	6 (3.1)	0 (0)	11 (5.8)	1 (0.5)
AMI	3 (1.5)	6 (3.0)	2 (1.0)	4 (2.1)	9 (4.6)	4 (2.1)	0 (0)	11 (5.8)	0 (0)
Stroke	1 (0.5)	3 (1.5)	3 (1.5)	0 (0)	3 (1.5)	3 (1.0)	1 (0.5)	2 (1.1)	3 (1.6)
Angina	5 (2.6)	1 (0.5)	0 (0)	3 (1.6)	0 (0)	0 (0)	1 (0.5)	1 (0.5)	3 (1.0)
Resource use, n events/100 patients
Repeat revascularization (any)	12.3	5.0	4.6	5.8	7.1	3.7	1.6	5.3	1.1
PCI procedure	12.3	2.5	0.5	5.2	3.6	0.5	1.1	1.6	0.5
CABG procedure	0.0	2.5	4.1	0.5	3.6	3.1	0.5	3.7	0.5
Bare metal stent	11.3	3.0	1.0	4.2	4.6	0.5	1.1	1.6	0.5
Balloon angioplasty	21.5	3.0	1.5	9.9	5.6	0.5	1.1	1.6	0.5
Diagnostic catheterization	15.4	5.5	15.9	11.0	6.1	4.2	3.7	10.1	1.1
Cost per patient, $
Medication	47 ± 32 [39]	80 ± 104 [64]	39 ± 29 [30]	93 ± 63 [78]	162 ± 210 [127]	78 ± 58 [60]	93 ± 63 [78]	163 ± 212 [127]	72 ± 53 [56]
Outpatient service	116 ± 82 [91]	111 ± 116 [85]	90 ± 82 [61]	160 ± 99 [124]	200 ± 229 [157]	115 ± 72 [98]	146 ± 81 [123]	209 ± 223 [166]	110 ± 71 [97]
PCI procedure	150 ± 433 [0]	34 ± 221 [0]	10 ± 141 [0]	63 ± 360 [0]	48 ± 290 [0]	6 ± 90 [0]	13 ± 127 [0]	20 ± 155 [0]	7 ± 91 [0]
CABG procedure	0	48 ± 304 [0]	80 ± 387 [0]	10 ± 141 [0]	69 ± 361 [0]	61 ± 340 [0]	10 ± 141 [0]	72 ± 369 [0]	10 ± 143 [0]
Revascularization procedure (any)	150 ± 433 [0]	83 ± 371 [0]	90 ± 410 [0]	73 ± 385 [0]	118 ± 456 [0]	48 ± 294 [0]	23 ± 190 [0]	92 ± 397 [0]	17 ± 234 [0]
Total	221 ± 474 [54]	120 ± 408 [18]	146 ± 417 [16]	233 ± 432 [124]	316 ± 576 [160]	183 ± 365 [100]	171 ± 222 [123]	306 ± 489 [170]	131 ± 281 [97]

	Year 4			Year 5			5-years cumulative
	PCI (n = 188)	MT (n = 178)	CABG (n = 183)	PCI (n = 182)	MT (n = 170)	CABG (n = 178)	PCI (n = 195)	MT (n = 201)	CABG (n = 195)	P value^c
Clinical outcomes, n (%)
Death	7 (3.7)	8 (4.5)	6 (3.3)	5 (2.7)	2 (1.2)	7 (3.9)	18 (9.2)	33 (16.4)	24 (12.3)	0.098^a
AMI	5 (2.6)	2 (1.1)	1 (0.5)	2 (1.1)	2 (1.2)	7 (3.9)	14 (7.2)	30 (14.9)	14 (7.2)	0.022^a
Stroke	0 (0)	3 (1.7)	2 (1.1)	2 (1.1)	2 (1.2)	0 (0)	4 (2.1)	13 (6.5)	11 (5.6)	0.178^a
Angina	2 (1.1)	1 (0.6)	1 (0.5)	4 (2.2)	4 (2.4)	6 (3.4)	15 (7.7)	7 (3.5)	10 (5.1)	0.395^a
Resource use, n events/100 patients
Repeat revascularization (any)	3.2	1.7	0.0	5.5	7.6	1.1	27.7	24.9	10.3	0.001^a
PCI procedure	2.1	1.1	0.0	4.4	2.9	1.1	24.6	10.9	2.6	< 0.001^a
CABG procedure	1.1	0.6	0.0	1.1	4.7	0.0	3.1	13.9	7.7	< 0.001^a
Bare metal stent	0.5	1.1	0.0	3.3	4.1	1.1	20.0	13.4	3.1	0.014^a
Balloon angioplasty	2.7	1.1	0.0	4.4	5.3	1.1	39.0	15.4	3.6	< 0.001^a
Diagnostic catheterization	4.8	3.4	0.5	12.6	14.7	7.3	46.2	36.3	28.2	0.042^a
Cost per patient, $
Medication	93 ± 63 [78]	165 ± 218 [127]	77 ± 57 [72]	92 ± 63 [78]	166 ± 222 [127]	77 ± 57 [60]	403 ± 284 [329]	680 ± 939 [558]	334 ± 255 [262]	< 0.001^b
Outpatient service	148 ± 83 [123]	199 ± 228 [158]	108 ± 63 [96]	162 ± 97 [127]	220 ± 246 [168]	120 ± 76 [100]	707 ± 373 [635]	867 ± 995 [733]	523 ± 306 [470]	< 0.001^b
PCI procedure	18 ± 126 [0]	14 ± 131 [0]	0	48 ± 297 [0]	42 ± 257 [0]	14 ± 131 [0]	287 ± 717 [0]	149 ± 473 [0]	36 ± 226 [0]	< 0.001^b
CABG procedure	20 ± 200 [0]	11 ± 146 [0]	0	21 ± 203 [0]	91 ± 413 [0]	0	60 ± 337 [0]	271 ± 676 [0]	151 ± 522 [0]	< 0.001^b
Revascularization procedure (any)	38 ± 234 [0]	25 ± 195 [0]	0	69 ± 357 [0]	134 ± 508 [0]	14 ± 131 [0]	347 ± 802 [0]	420 ± 849 [0]	167 ± 553 [0]	0.003^b
Total	189 ± 283 [123]	229 ± 32 [161]	111 ± 65 [97]	235 ± 413 [133]	359 ± 606 [176]	142 ± 171 [103]	1402 ± 1780 [673]	1707 ± 2090[0]	877 ± 1184 [501]	< 0.001^b

Values in brackets represent medians
MT medical treatment, PCI percutaneous coronary intervention, CABG coronary artery bypass graft, AMI acute myocardial infarction, $ American dollar
^aChi square test of homogeneity
^bKruskal–Wallis
^cP value refers to 5-years cumulative

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