AIMS: When patients choose percutaneous coronary intervention (PCI) over coronary artery bypass grafting (CABG), they accept an increased long-term risk of repeat revascularisation in exchange for short-term morbidity benefits. This paper quantifies the risk-benefit trade-off faced by patients with multiple vessel coronary artery disease. METHODS AND RESULTS: Data from the Arterial Revascularisation Therapies Study are used to generate risk-benefit acceptability curves for PCI versus CABG. Risks are measured by the long-term likelihood of repeat revascularisation while benefits are measured by short-term reductions in pain or improvements in health-related quality of life (HRQL). PCI patients faced a risk of 0.81 additional revascularisation events over three years in exchange for being pain-free at one month. A patient would need to be willing to tolerate a risk of 1.06 additional revascularisation events at three years, in exchange for being pain free at one month to be 95% confident that choosing PCI over CABG is risk-effective for him/her. CONCLUSIONS: The risk-benefit framework outlined in this study provides information to enable physicians to help their patients weigh directly each procedure's risks and benefits. While trade-offs are typically measured in quality-adjusted life years, using pain reduction to reflect benefits may provide a more tangible framework for patients.
AIMS: When patients choose percutaneous coronary intervention (PCI) over coronary artery bypass grafting (CABG), they accept an increased long-term risk of repeat revascularisation in exchange for short-term morbidity benefits. This paper quantifies the risk-benefit trade-off faced by patients with multiple vessel coronary artery disease. METHODS AND RESULTS: Data from the Arterial Revascularisation Therapies Study are used to generate risk-benefit acceptability curves for PCI versus CABG. Risks are measured by the long-term likelihood of repeat revascularisation while benefits are measured by short-term reductions in pain or improvements in health-related quality of life (HRQL). PCI patients faced a risk of 0.81 additional revascularisation events over three years in exchange for being pain-free at one month. A patient would need to be willing to tolerate a risk of 1.06 additional revascularisation events at three years, in exchange for being pain free at one month to be 95% confident that choosing PCI over CABG is risk-effective for him/her. CONCLUSIONS: The risk-benefit framework outlined in this study provides information to enable physicians to help their patients weigh directly each procedure's risks and benefits. While trade-offs are typically measured in quality-adjusted life years, using pain reduction to reflect benefits may provide a more tangible framework for patients.
Authors: Wolfgang Greiner; Tom Weijnen; Martin Nieuwenhuizen; Siem Oppe; Xavier Badia; Jan Busschbach; Martin Buxton; Paul Dolan; Paul Kind; Paul Krabbe; Arto Ohinmaa; David Parkin; Montserat Roset; Harri Sintonen; Aki Tsuchiya; Frank de Charro Journal: Eur J Health Econ Date: 2003-09
Authors: Patrick W Serruys; Andrew T L Ong; Lex A van Herwerden; J Eduardo Sousa; Adib Jatene; Johannes J R M Bonnier; Jacques P M A Schönberger; Nigel Buller; Robert Bonser; Clemens Disco; Bianca Backx; Paul G Hugenholtz; Brian G Firth; Felix Unger Journal: J Am Coll Cardiol Date: 2005-08-16 Impact factor: 24.094
Authors: Edward L Hannan; Chuntao Wu; Gary Walford; Alfred T Culliford; Jeffrey P Gold; Craig R Smith; Robert S D Higgins; Russell E Carlson; Robert H Jones Journal: N Engl J Med Date: 2008-01-24 Impact factor: 91.245
Authors: Patrick W Serruys; Marie-Claude Morice; A Pieter Kappetein; Antonio Colombo; David R Holmes; Michael J Mack; Elisabeth Ståhle; Ted E Feldman; Marcel van den Brand; Eric J Bass; Nic Van Dyck; Katrin Leadley; Keith D Dawkins; Friedrich W Mohr Journal: N Engl J Med Date: 2009-02-18 Impact factor: 91.245
Authors: Victor M G Legrand; Patrick W Serruys; Felix Unger; Ben A van Hout; Mathias C M Vrolix; Geert M P Fransen; Torsten Toftegaard Nielsen; Peter Kildeberg Paulsen; Ricardo Seabra Gomes; João M G de Queiroz e Melo; José P Marques dos Santos Neves; Wietze Lindeboom; Bianca Backx Journal: Circulation Date: 2004-03-01 Impact factor: 29.690
Authors: Ron T van Domburg; Joost Daemen; Susanne S Pedersen; Marco Bressers; Lex A van Herwerden; Brian G Firth; Felix Unger; Patrick W Serruys Journal: EuroIntervention Date: 2008-01 Impact factor: 6.534