Favarato Desiderio, Hueb Whady, Gersh Bernard J, Soares Paulo R, Cesar Luiz A M, da Luz Protásio L, Oliveira Sergio A, Ramires Jose A F
Heart Institute (InCor), University of Sao Paulo School of Medicine, São Paulo/SP, Brazil.
Circulation. 2003 Sep 9;108 Suppl 1:II21-3. doi: 10.1161/01.cir.0000087381.98299.7b.
Prior comparisons of costs following CABG and PTCA have demonstrated higher initial costs after CABG but following PTCA, recurrent symptoms and repeat revascularization result in increased late costs and over time their costs equilibrate. The MASS II trial provides an opportunity to compare the costs of CABG and PTCA in addition to a strategy of medical therapy.
We studied the 611 patients of MASS II [Medical (203), Angioplasty (205), or Surgery (203) Study], a randomized study to compare treatments for multivessel CAD and preserved left ventricle function. The costs were: CABG 10,650.00 US dollars; PTCA 6400.00 US dollars; new AMI hospitalization AMI 2550 US dollars; angiography not followed-up of PTCA 1900.00 US dollars; and medication 1200.00 US dollars for medical, and 1000.00 US dollars for the other groups. We did adjustment for average event-free time, and angina-free proportion. The statistical analysis carried out was chi-square, t test, and analysis of variance.
After 1 year, 49% Medical, 79% PTCA, and 88% CABG became angina-free; P<0.0001. There were 26 coronary angiograms (5 medical, 17 PTCA, and 4 CABG), 23 AMI (8 medical, 17 PTCA, and 6 CABG; P=0.03); PTCA was performed in 7 Medical, 17 PTCA, and 1 CABG, (P=0.0003), CABG was performed in 15 Medical, 8 PTCA, and zero CABG; P=0.002. The event-free and event and angina-free-costs in the first year were 2453.50 US dollars and 5006.32 US dollars for Medical; 10348,43 US dollars; and 13,099.31 US dollars for PTCA; and 12,404.21 US dollars and 14,095.09 US dollars for CABG group. An increase from expected costs of 317%, 77%, and 21%, respectively.
PTCA effective costs were similar to CAGB costs, Medical treatment presented the lowest cost, and however, the greatest increment, and CABG presented the most stable costs.
先前对冠状动脉旁路移植术（CABG）和经皮冠状动脉腔内血管成形术（PTCA）术后成本的比较表明，CABG术后的初始成本较高，但PTCA术后，复发症状和重复血运重建会导致后期成本增加，随着时间推移，它们的成本会趋于平衡。MASS II试验提供了一个机会，除了比较药物治疗策略外，还可比较CABG和PTCA的成本。
我们研究了MASS II[药物治疗（203例）、血管成形术（205例）或手术治疗（203例）研究]中的611例患者，这是一项比较多支冠状动脉疾病和左心室功能保留患者治疗方法的随机研究。成本如下：CABG为10,650.00美元；PTCA为6400.00美元；新发急性心肌梗死（AMI）住院费用为2550美元；PTCA后未进行随访的血管造影费用为1900.00美元；药物治疗组药物费用为1200.00美元，其他组为1000.00美元。我们对平均无事件时间和无心绞痛比例进行了调整。进行的统计分析包括卡方检验、t检验和方差分析。
1年后，药物治疗组49%、PTCA组79%、CABG组88%的患者无心绞痛；P<0.0001。共进行了26次冠状动脉造影（药物治疗组5次、PTCA组17次、CABG组4次），发生23例AMI（药物治疗组8例、PTCA组17例、CABG组6例；P=0.03）；药物治疗组7例、PTCA组17例、CABG组1例进行了PTCA（P=0.0003），药物治疗组15例、PTCA组8例、CABG组0例进行了CABG；P=0.002。药物治疗组第一年的无事件成本和无事件及无心绞痛成本分别为2453.50美元和5006.32美元；PTCA组为10348.43美元和13,099.31美元；CABG组为12,404.21美元和14,095.09美元。分别比预期成本增加了317%、77%和21%。
PTCA的有效成本与CAGB成本相似，药物治疗成本最低，但增加幅度最大，CABG成本最稳定。
