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.