TY - JOUR
T1 - Treatment for stable coronary artery disease
T2 - A network meta-analysis of cost-effectiveness studies
AU - Caruba, Thibaut
AU - Katsahian, Sandrine
AU - Schramm, Catherine
AU - Nelson, Anaïs Charles
AU - Durieux, Pierre
AU - Bégué, Dominique
AU - Juillière, Yves
AU - Dubourg, Olivier
AU - Danchin, Nicolas
AU - Sabatier, Brigitte
PY - 2014/6/4
Y1 - 2014/6/4
N2 - Introduction and Objectives: Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG). Methods: RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs. Results: Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3- year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG. Conclusions: Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina.
AB - Introduction and Objectives: Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG). Methods: RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs. Results: Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3- year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG. Conclusions: Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina.
UR - https://www.scopus.com/pages/publications/84902436214
U2 - 10.1371/journal.pone.0098371
DO - 10.1371/journal.pone.0098371
M3 - Article
C2 - 24896266
AN - SCOPUS:84902436214
SN - 1932-6203
VL - 9
JO - PLoS ONE
JF - PLoS ONE
IS - 6
M1 - e98371
ER -