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Previous Volume 336:92-99 January 9, 1997 Number 2 Next

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ABSTRACT

Background Randomized trials comparing coronary angioplasty with bypass surgery in patients with multivessel coronary disease have shown no significant differences in overall rates of death and myocardial infarction. We compared quality of life, employment, and medical care costs during five years of follow-up among patients treated with angioplasty or bypass surgery.

Methods A total of 934 of the 1829 patients enrolled in the randomized Bypass Angioplasty Revascularization Investigation participated in this study. Detailed data on quality of life were collected annually, and economic data were collected quarterly.

Results During the first three years of follow-up, functional-status scores on the Duke Activity Status Index, which measures the ability to perform common activities of daily living, improved more in patients assigned to surgery than in those assigned to angioplasty (P<0.05). Other measures of quality of life improved equally in both groups throughout the follow-up period. Patients in the angioplasty group returned to work five weeks sooner than did patients in the surgery group (P<0.001). The initial mean cost of angioplasty was 65 percent that of surgery ($21,113 vs. $32,347, P<0.001), but after five years the total medical cost of angioplasty was 95 percent that of surgery ($56,225 vs. $58,889), a difference of $2,664 (P = 0.047). The five-year cost of angioplasty was significantly lower than that of surgery among patients with two-vessel disease ($52,930 vs. $58,498, P<0.05), but not among patients with three-vessel disease ($60,918 vs. $59,430). After five years of follow-up, surgery had an overall cost-effectiveness ratio of $26,117 per year of life added, but unacceptable ratios of $100,000 or more per year of life added could not be excluded (P = 0.13). Surgery appeared particularly cost effective in treating patients with diabetes because of their significantly improved survival.

Conclusions In patients with multivessel coronary disease, coronary-artery bypass surgery is associated with a better quality of life for three years than coronary angioplasty, after the initial morbidity caused by the procedure. Coronary angioplasty has a lower five-year cost than bypass surgery only in patients with two-vessel coronary disease.

Source Information

From the Stanford University School of Medicine, Stanford, Calif. (M.A.H., I.J., D.B.); the University of Alabama Medical Center, Birmingham (W.J.R.); the University of Pittsburgh Graduate School of Public Health, Pittsburgh (M.M.B.); the University of Michigan School of Medicine, Ann Arbor (B.P.); the Mayo Clinic, Rochester, Minn. (G.R., H.S.); Boston University School of Medicine, Boston (T.R.); the Cleveland Clinic Foundation, Cleveland (P.W.); St. Louis University School of Medicine, St. Louis (R.W.); and Duke University School of Medicine, Durham, N.C. (D.B.M.). Other authors were Allan D. Rosen, M.S., and Katherine Detre, M.D., Dr.P.H. (University of Pittsburgh Graduate School of Public Health), and Robert L. Frye, M.D. (Mayo Clinic).

Address reprint requests to Dr. Hlatky at Stanford University School of Medicine, HRP Redwood Bldg., Rm. 150, Stanford, CA 94305-5092.

Full Text of this Article

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