Cost Effectiveness of Percutaneous Coronary Intervention in Optimally Treated Stable Coronary Patients
A recent study evaluated the relative cost and cost-effectiveness of percutaneous coronary intervention (PCI) in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive drug Evaluations) trial.
Resource use was assessed by looking at the diagnosis-related group for hospitalizations and by current procedural terminology codes for outpatient visits and tests and then converted to costs by use of 2004 Medicare payments. Life expectancy beyond the trial was estimated from Framingham survival data.
The added cost of PCI was approximately $10,000, without significant gain in life-years or quality-adjusted life years. A larger minority of the distributions found that medical therapy alone offered better outcome at lower cost.
Per patient costs associated with significant improvement in angina frequency, physical limitation and quality of life were $154,580, $112,876, and $124,233, respectively.
Primary study endpoints of death or myocardial infarction remain the same between the treatment groups but quality of life based on angina symptom improvement was seen in the PCI group. However, the costs associated with clinical improvement in angina were $100,000.
As an initial management strategy for symptomatic, chronic coronary artery disease, adding PCI to optimal medical therapy was not found to be cost-effective. Current evidence, therefore, based on clinical and economic outcomes of this study suggest that medical therapy in chronic stable coronary artery disease is the appropriate option, but adding PCI to optimal medical therapy is not cost-effective as stated earlier.
About the author
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.
