BACKGROUND: A short saphenous vein segment is commonly used as a conduit for coronary artery bypass grafting, and clinicians must decide whether to obtain it by performing open (OVH) or endoscopic vein harvest (EVH). We conducted a health economic evaluation, using data on resource usage collected alongside a randomized controlled trial, to investigate whether EVH is cost-effective compared with OVH. METHODS: Analyses were performed in accordance with international guidelines for health economic evaluations. We constructed 3 cost-levels as the current literature is inconclusive as to which resource consumptions differ significantly between harvesting methods. Outcomes were measured as purulent infections avoided in the cost-effectiveness analysis and for the cost-utility analysis we estimated quality-adjusted life-years gained. Results were presented as incremental cost-effectiveness ratios: ie, the extra cost of obtaining one extra quality-adjusted life-year and the extra cost of avoiding one purulent infection. To handle uncertainties, we performed bias corrected bootstrap analyses on 5,000 resamples and constructed cost-effectiveness acceptability curves. RESULTS: The incremental cost-effectiveness ratio was $79,391/quality-adjusted life-year and $1,970/purulent infection avoided when costs and outcomes within 35 days postoperatively were compared. Within 35 days postoperatively, EVH was less than 1% cost-effective at a willingness-to-pay threshold of $50,000/quality-adjusted life-year. CONCLUSIONS: The EVH was not cost-effective within 35 days postoperatively. Future studies should investigate long-term cost effectiveness.
BACKGROUND: A short saphenous vein segment is commonly used as a conduit for coronary artery bypass grafting, and clinicians must decide whether to obtain it by performing open (OVH) or endoscopic vein harvest (EVH). We conducted a health economic evaluation, using data on resource usage collected alongside a randomized controlled trial, to investigate whether EVH is cost-effective compared with OVH. METHODS: Analyses were performed in accordance with international guidelines for health economic evaluations. We constructed 3 cost-levels as the current literature is inconclusive as to which resource consumptions differ significantly between harvesting methods. Outcomes were measured as purulent infections avoided in the cost-effectiveness analysis and for the cost-utility analysis we estimated quality-adjusted life-years gained. Results were presented as incremental cost-effectiveness ratios: ie, the extra cost of obtaining one extra quality-adjusted life-year and the extra cost of avoiding one purulent infection. To handle uncertainties, we performed bias corrected bootstrap analyses on 5,000 resamples and constructed cost-effectiveness acceptability curves. RESULTS: The incremental cost-effectiveness ratio was $79,391/quality-adjusted life-year and $1,970/purulent infection avoided when costs and outcomes within 35 days postoperatively were compared. Within 35 days postoperatively, EVH was less than 1% cost-effective at a willingness-to-pay threshold of $50,000/quality-adjusted life-year. CONCLUSIONS: The EVH was not cost-effective within 35 days postoperatively. Future studies should investigate long-term cost effectiveness.
Authors: Bhuvaneswari Krishnamoorthy; William R Critchley; Rajamiyer V Venkateswaran; James Barnard; Ann Caress; James E Fildes; Nizar Yonan Journal: J Cardiothorac Surg Date: 2016-04-08 Impact factor: 1.637
Authors: Bart S Ferket; Jonathan M Oxman; Alexander Iribarne; Annetine C Gelijns; Alan J Moskowitz Journal: J Thorac Cardiovasc Surg Date: 2017-11-15 Impact factor: 5.209