Leyva Francisco, Qiu Tian, Evison Felicity, Christoforou Christopher, McNulty David, Ludman Peter, Ray Daniel
Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK.
Quality and Outcomes Research Unit, Queen Elizabeth Hospital, Birmingham, UK.
Open Heart. 2018 Jan 3;5(1):e000704. doi: 10.1136/openhrt-2017-000704. eCollection 2018.
Healthcare expenditure per-capita in the USA is higher than in England. We hypothesised that clinical outcomes after cardiac revascularisation are better in the USA. We compared costs and outcomes of patients undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in England and New York State (NYS).
Costs and total mortality were assessed using the Hospital Episode Statistics for England and the Statewide Planning and Research Cooperative System for NYS. Outcomes after a first CABG or PCI were assessed in patients undergoing a first CABG (n=142 969) or PCI (n=431 416).
After CABG, crude total mortality in England was 0.72% lower at 30 days and 3.68% lower at 1 year (both P<0.001). After PCI, crude total mortality was 0.35% lower at 30 days and 3.55% lower at 1 year (both P<0.001). No differences emerged in total mortality at 30 days after either CABG (England: HR 1.02,95% CI 0.94 to 1.10) or PCI (HR 1.04, 95% CI 0.99 to 1.09) after covariate adjustment. At 1 year, adjusted total mortality was lower in England after both CABG (HR 0.74, 95% CI 0.71 to 0.78) and PCI (HR 0.66, 95% CI 0.65 to 0.68). After adjustment for cost-to-charge ratios and purchasing power parities, costs in NYS amounted to uplifts of 3.8-fold for CABG and 3.6-fold for PCI.
Total mortality after CABG and PCI was similar at 30 days and lower in England at 1 year. Costs were approximately fourfold higher in NYS.
美国人均医疗保健支出高于英国。我们假设美国心脏血运重建后的临床结局更好。我们比较了英格兰和纽约州（NYS）接受冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）患者的成本和结局。
使用英格兰的医院事件统计数据和纽约州的全州规划与研究合作系统评估成本和总死亡率。对首次接受CABG（n = 142969）或PCI（n = 431416）的患者评估首次CABG或PCI后的结局。
CABG后，英格兰30天的粗总死亡率低0.72%，1年时低3.68%（均P<0.001）。PCI后，30天的粗总死亡率低0.35%，1年时低3.55%（均P<0.001）。在进行协变量调整后，CABG（英格兰：HR 1.02，95%CI 0.94至1.10）或PCI（HR 1.04，95%CI 0.99至1.09）后30天的总死亡率均无差异。1年时，CABG（HR 0.74，95%CI 0.71至0.78）和PCI（HR 0.66，95%CI 0.65至0.68）后英格兰的调整后总死亡率均较低。在对成本收费比和购买力平价进行调整后，纽约州CABG的成本提高了3.8倍，PCI的成本提高了3.6倍。
CABG和PCI后30天的总死亡率相似，1年时英格兰的总死亡率较低。纽约州的成本大约高出四倍。
