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
Term
4. term
Publication year
2011
Submitted on
2011-05-31
Pages
14
Abstract
BACKGROUND A short saphenous vein segment is commonly used as a conduit for coronary artery bypass grafting (CABG), and clinicians must decide whether to obtain it by performing a traditional open vein harvest (OVH) or by performing an endoscopic vein harvest (EVH). We conducted a post hoc cost-utility analysis (CUA), based on a published study and from the Danish healthcare system´s viewpoint, to investigate whether EVH is cost-effective when compared to OVH. METHODS The economic analysis was performed using a 35 day follow-up period and in accordance with international guidelines. We constructed four cost-levels as the current literature is inconclusive as to which resource consumptions differ significantly between EVH and OVH. Outcomes were assessed by performing a quality of life conversion of patients´ postoperative pain, satisfaction with cosmetic results and observational data on mobility. We performed bias corrected bootstrap analyses on 5,000 re-samples to calculate the incremental cost-effectiveness ratio (ICER) and to construct cost-effectiveness acceptability curves (CEACs). Results were tested against a willingness-to-pay (WTP) threshold of £ 30,000/quality adjusted life-years (QALY). RESULTS When costs and outcomes within the first 35 days were compared, the ICER was £ 64,482/QALY but <1 % cost-effective at a WTP of £ 30,000/QALY. Adding costs of treatments of surgical wound infections of the leg, which were already initiated at 35 days postoperatively, the ICER dropped to £ 38,876/QALY, and EVH became approximately 2 % cost-effective at a WTP of £ 30,000/QALY. If mobility was excluded from the measurement of outcome, EVH was <1 % cost-effective at a WTP of £ 30,000/QALY. CONCLUSION We conclude that, within the first five weeks postoperatively, EVH is not a cost-effective method for harvesting a short saphenous vein segment during CABG, when compared to OVH.
Keywords
Documents