Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Headington, UK.
Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.
Heart. 2017 Nov;103(21):1719-1726. doi: 10.1136/heartjnl-2016-311058. Epub 2017 Apr 27.
Coronary artery bypass grafting (CABG) using bilateral internal mammary arteries (BIMA) may improve survival over CABG using single internal mammary arteries (SIMA), but may be surgically more complex (and therefore costly) and associated with impaired sternal wound healing. We report, for the first time, a detailed comparison of healthcare resource use and costs over 12 months, as part of the Arterial Revascularisation (ART) Trial.
3102 patients in 28 hospitals in seven countries were randomised to CABG surgery using BIMA (n=1548) or SIMA (n=1554). Detailed resource use data were collected covering surgery, the initial hospital episode, and for 12 months post randomisation. Using UK unit costs, total costs were calculated and compared between trial arms and for subgroups.
Patients randomised to BIMA spent 20 min longer in theatre (95% CI 15 to 25, p<0.001) and also required more treatment for sternal wound problems. Mean (SD) total costs per patient at 12 months were £13 839 (£10 534) for BIMA and £12 717 (£9719) for SIMA (mean cost difference £1122, 95% CI £407 to £1838, p=0.002). No tests for interaction between subgroups and treatment allocation were significant.
At 12 months from randomisation, mean costs were approximately 9% higher in BIMA than SIMA patients, primarily due to longer time in theatre and in-hospital stay, and slightly higher costs related to sternal wound problems during follow-up. Follow-up to the primary trial endpoint of 10 years will reveal whether longer-term differences emerge in graft patency or in overall survival.
Controlled-trials.com (ISRCTN46552265).
与使用单根内乳动脉（SIMA）进行冠状动脉旁路移植术（CABG）相比，使用双侧内乳动脉（BIMA）进行 CABG 可能会提高存活率，但手术可能更复杂（因此成本更高），并且与胸骨伤口愈合受损有关。我们首次报告了 12 个月内医疗资源使用和成本的详细比较，这是 Arterial Revascularisation（ART）试验的一部分。
在七个国家的 28 家医院中，3102 名患者被随机分为使用 BIMA（n=1548）或 SIMA（n=1554）进行 CABG 手术。收集了详细的资源使用数据，涵盖手术、初始住院期间以及随机分组后 12 个月。使用英国单位成本，计算了试验组之间和亚组之间的总费用并进行了比较。
随机分配到 BIMA 的患者在手术室中多花费了 20 分钟（95%CI 15 至 25，p<0.001），并且还需要更多的胸骨伤口问题治疗。12 个月时每位患者的平均（SD）总费用为 BIMA 组为 13839 英镑（10534 英镑），SIMA 组为 12717 英镑（9719 英镑）（平均费用差异为 1122 英镑，95%CI 407 至 1838 英镑，p=0.002）。没有发现亚组和治疗分配之间存在交互作用的检验。
随机分组后 12 个月时，BIMA 患者的平均费用比 SIMA 患者高出约 9%，这主要是由于手术时间和住院时间较长，以及随访期间胸骨伤口问题的稍高成本。对主要试验终点 10 年的随访将揭示在移植物通畅性或总体存活率方面是否会出现更长期的差异。
Controlled-trials.com（ISRCTN46552265）。
