Cost-effectiveness of endoscopic versus open harvest of a short saphenous vein segment for coronary artery bypass grafting: A post hoc health economic evaluation of a randomised controlled trial
Translated title
Omkostningseffektivitet af endoskopisk versus åben høst af et kort segment af vena saphena til bypass kirurgi
Author
Oddershede, Lars
Term
4. term
Publication year
2011
Submitted on
2011-05-31
Pages
14
Abstract
Baggrund: Ved koronar bypass-operation (CABG) bruges ofte et kort saphenøst venesegment som bypass, og kirurger kan udtage venen enten med åben venefjernelse (OVH) eller endoskopisk venefjernelse (EVH). Vi udførte en post hoc omkostnings-nytteanalyse (CUA) baseret på et publiceret studie og set fra det danske sundhedsvæsens perspektiv for at undersøge, om EVH er omkostningseffektiv sammenlignet med OVH. Metode: Analysen omfattede de første 35 dage postoperativt og fulgte internationale retningslinjer. Vi opstillede fire omkostningsniveauer, fordi litteraturen er uklar om, hvilke ressourceforbrug der adskiller EVH fra OVH. Udfald blev omregnet til livskvalitet ved at kombinere patienternes postoperative smerte, tilfredshed med kosmetiske resultater og observeret mobilitet til kvalitetsjusterede leveår (QALY). Vi anvendte bias-korrigeret bootstrap med 5.000 genprøver til at beregne den inkrementelle omkostnings-effektivitets-ratio (ICER) og konstruere acceptabilitetskurver for omkostningseffektivitet (CEAC). Resultaterne blev vurderet mod en betalingsvillighedsgrænse (WTP) på £30.000 per QALY. Kort forklaret: QALY kombinerer længde og kvalitet af liv; ICER er den ekstra omkostning per ekstra QALY; CEAC viser sandsynligheden for omkostningseffektivitet ved forskellige WTP-grænser. Resultater: Inden for de første 35 dage var ICER £64.482/QALY, og EVH var under 1 % sandsynlig for at være omkostningseffektiv ved en WTP på £30.000/QALY. Når omkostninger til behandling af kirurgiske sårinfektioner på benet, som allerede var påbegyndt 35 dage postoperativt, blev medregnet, faldt ICER til £38.876/QALY, og EVH blev cirka 2 % omkostningseffektiv ved £30.000/QALY. Hvis mobilitet blev udeladt fra udfaldsmålet, var EVH under 1 % omkostningseffektiv ved £30.000/QALY. Konklusion: Inden for de første fem uger efter operation er EVH ikke en omkostningseffektiv metode til udtagning af et kort saphenøst venesegment under CABG sammenlignet med OVH.
Background: In coronary artery bypass grafting (CABG), a short saphenous vein segment is often used as a conduit, and surgeons can harvest it by either open vein harvest (OVH) or endoscopic vein harvest (EVH). We conducted a post hoc cost-utility analysis (CUA), based on a published study and from the perspective of the Danish healthcare system, to examine whether EVH is cost-effective compared with OVH. Methods: The economic analysis covered the first 35 days after surgery and followed international guidelines. We modeled four cost scenarios because the literature is inconclusive about which resource uses differ between EVH and OVH. Outcomes were converted into quality-of-life measures by combining patients’ postoperative pain, satisfaction with cosmetic results, and observed mobility into quality-adjusted life years (QALY). We used bias-corrected bootstrap with 5,000 resamples to estimate the incremental cost-effectiveness ratio (ICER) and to build cost-effectiveness acceptability curves (CEAC). Results were assessed against a willingness-to-pay (WTP) threshold of £30,000 per QALY. In brief: QALY combines length and quality of life; ICER is the extra cost per extra QALY; CEAC shows the probability of cost-effectiveness at different WTP thresholds. Results: Within the first 35 days, the ICER was £64,482/QALY, and EVH was less than 1% likely to be cost-effective at a WTP of £30,000/QALY. When the costs of treating leg surgical wound infections already initiated by day 35 were included, the ICER fell to £38,876/QALY, and EVH became approximately 2% cost-effective at £30,000/QALY. If mobility was excluded from the outcome measure, EVH was less than 1% cost-effective at £30,000/QALY. Conclusion: During the first five weeks after surgery, EVH is not a cost-effective method for harvesting a short saphenous vein segment during CABG compared with OVH.
[This abstract was generated with the help of AI]
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