Cost-Effectiveness of PCI with Drug Eluting Stents versus Bypass Surgery for Patients with Diabetes and Multi-vessel Coronary Artery Disease: Results from the FREEDOM Trial.
Not only did patients with diabetes and multi-vessel CAD experience significantly better clinical outcomes after revascularization with CABG than PCI with a drug-eluting stent, according to results of the FREEDOM trial, based on lifetime projections, CABG was found to be more cost‐effective compared to DES‐PCI.
Although the initial cost of CABG was higher than PCI, 5-year follow-up suggests that the improved clinical outcomes associated with the procedure in patients with diabetes and multi-vessel CAD leads to lower long-term costs, according to a cost-effectiveness analysis of the FREEDOM trial.
“QALY + ICER gain[1]” presented during the 2012 AHA Scientific Sessions in Los Angeles evaluated the cost‐effectiveness of CABG vs. DES‐PCI for diabetic patients having multi‐vessel revascularization, complimenting the clinical results of the FREEDOM trial. The Incremental cost‐effectiveness ratio (ICER) against the cost per quality‐adjusted life year gained (QALY) was compared.
CABG Initial Costs, 5‐Year, projected Lifetime Results:
| CABG | Initial Costs: CABG>PCI | 5‐Year | Lifetime |
| $/Patient | $8622/patient p=<0.001 | $3641/patient | $5392/patient |
| QALY + | 0.031 QALY | 0.66 QALY | |
| ICER gain | $116,699/QALY | $8,132/QALY |
- Initial costs ‐ CABG $8622/patient more than DES‐PCI (p=<0.001)
- 5-year costs – CABG: $3641/patient, 0.031 QALY improvement, and a ICER gain of $116,699/QALY.
- Lifetime cost‐effectiveness ratio ‐ 0.66 gain in QALY, CABG costs of $5392 /patient (ICER gain of $8,132/QALY for CABG).
Conclusions: For diabetic patients with multi-vessel disease, initial costs for CABG were higher than for PCI because of hospital stay and early complications. Total 5‐year costs for CABG were also higher, but the follow-up costs for PCI were greater. However, based on lifetime projections, CABG was found to be more cost‐effective compared to DES‐PCI.
This study is consistent with previous publications, notably an analysis[2] indicating that clinically appropriate PCI was not cost effective within 12 months following the intervention.
Despite the large increase in numbers of percutaneous coronary intervention procedures seen in many countries, we do not find this result surprising: the high costs of PCI and the need for subsequent procedures, absence of any mortality benefit (except in STEMI), and absence of a marked gain in quality of life have all been separately reported in trials.
[1] QALY + ICER gain . Presented by: Magnuson EA, AHA Scientific Sessions, Los Angeles © 2012, American Heart Association.