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Objectives  Cost‐effectiveness of percutaneous coronary intervention (PCI) using drug‐eluting stents (DES), and coronary artery bypass surgery (CABG) was analyzed in patients with multivessel coronary artery disease over a 5‐year follow‐up.    Background  DES implantation reducing revascularization rate and associated costs might be attractive for health economics as compared to CABG.    Methods  Consecutive patients with multivessel DES‐PCI ( n  = 114, 3.3 ± 1.2 DES/patient) or CABG ( n  = 85, 2.7 ± 0.9 grafts/patient) were included prospectively. Primary endpoint was cost‐benefit of multivessel DES‐PCI over CABG, and the incremental cost‐effectiveness ratio (ICER) was calculated. Secondary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE), including acute myocardial infarction (AMI), all‐cause death, revascularization, and stroke.    Results  Despite multiple uses for DES, in‐hospital costs were significantly less for PCI than CABG, with 4551 €/patient difference between the groups. At 5‐years, the overall costs remained higher for CABG patients (mean difference 5400 € between groups). Cost‐effectiveness planes including all patients or subgroups of elderly patients, diabetic patients, or Syntax score >32 indicated that CABG is a more effective, more costly treatment mode for multivessel disease. At the 5‐year follow‐up, a higher incidence of MACCE (37.7% vs. 25.8%; log rank  P  = 0.048) and a trend towards more AMI/death/stroke (25.4% vs. 21.2%, log rank  P  = 0.359) was observed in PCI as compared to CABG. ICER indicated 45615 € or 126683 € to prevent one MACCE or AMI/death/stroke if CABG is performed.    Conclusions  Cost‐effectiveness analysis of DES‐PCI vs. CABG demonstrated that CABG is the most effective, but most costly, treatment for preventing MACCE in patients with multivessel disease. © 2014 Wiley Periodicals, Inc.

catheterization and cardiovascular interventions

Cost‐effectiveness of percutaneous coronary intervention with drug‐eluting stents in patients with multivessel coronary artery disease compared to coronary artery bypass surgery five‐years after intervention