Angioplasty Not Cost-Effective for Chronic Coronary Disease

WEDNESDAY Sept. 24, 2008 -- In patients with coronary artery disease, angioplasty isn't a cost-effective treatment, according to a U.S. study that assessed the costs of hospitalization and medication among 2,287 patients treated between 1999 and 2004.

The researchers analyzed data from the COURAGE trial and concluded that angioplasty may add $10,000 to treatment costs "without significant gain in life years or quality-adjusted life years."

Some of the patients received balloon angioplasty (percutaneous coronary intervention -- PCI) plus optimal medical therapy, while others received optimal medical therapy alone. The study found that 4.6 years after treatment, there was no difference in the two groups' rates of death or heart attack, but patients who received PCI did have an improved quality of life.

The researchers used Framingham study survival data to estimate patients' life expectancy beyond the COURAGE trial. The incremental cost-effectiveness ratio (ICER) was expressed as cost per life-year and cost per quality-adjusted life-year gained.

Patient ICERs ranged from $168,000 to $300,000 per life-year of quality-adjusted life-year gained with PCI, said the researchers, who noted that there's a reasonable probability that medical therapy alone offers better outcome at a lower cost. They found that the costs per patient for significant improvement in angina chest pain frequency, physical limitation and quality of life were $154,580, $112,876 and $124,233, respectively.

"The COURAGE trial did not find adding PCI to optimal medical therapy to be a cost-effective initial management strategy for symptomatic, chronic coronary artery disease," the researchers concluded.

The study was published in Circulation: Cardiovascular Quality and Outcomes.

More information

The U.S. National Heart, Lung, and Blood Institute has more about coronary artery disease.

Posted: September 2008


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