Todd H Wagner1, Brack Hattler2, Faisal G Bakaeen3, Joseph F Collins4, G Hossein Almassi5, Jacquelyn A Quin6, Frederick L Grover2, Muath Bishawi7, A Laurie W Shroyer8. 1. VA Palo Alto Health Economics Resource Center, Menlo Park, California; Department of Surgery, Stanford University, Palo Alto, California. Electronic address: todd.wagner@va.gov. 2. Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado. 3. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 4. Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland. 5. Veterans Affairs Medical Center, Milwaukee, Wisconsin; Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. 6. VA Boston Healthcare System, West Roxbury, Massachusetts. 7. Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. 8. Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Northport VA Medical Center, Northport, New York.
Abstract
BACKGROUND:Coronary artery bypass grafting (CABG) is a common surgical treatment for ischemic heart disease. Little is known about the long-term costs of conducting the surgery on-pump or off-pump. METHODS: As part of the Randomized On/Off Bypass follow-up study, we followed 2,203 participants randomized to on-pump (n = 1,099) and off-pump (n = 1,104) CABG for 5 years using Department of Veterans Affairs and Medicare administrative data. We examined annual costs through 5 years, standardized to 2016 dollars, using multivariate regression models, controlling for site and baseline patient factors. RESULTS: In the first year, including the CABG surgery, annual average costs were $66,599 (SE, $1,946) for the on-pump group and $70,552 (SE, $1,954) for the off-pump group. In years 2 to 5, average costs ranged from $15,000 to $20,000 per year. There was no significant difference between on-pump and off-pump across the 5 years. We explored differences among high-risk subgroups (diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular disease, renal dysfunction, ejection fraction < 35%, over age 70 years), and found no treatment assignment by time interactions, except for a nonsignificant trend in patients with diabetes. CONCLUSIONS: At 5 years, the average costs of off-pump and on-pump CABG patients did not statistically differ. Costs do not favor one approach and the decision should be based on clinical risks, especially in subgroups. Future research is warranted to examine post-CABG costs and outcomes for diabetic patients over time.
RCT Entities:
BACKGROUND: Coronary artery bypass grafting (CABG) is a common surgical treatment for ischemic heart disease. Little is known about the long-term costs of conducting the surgery on-pump or off-pump. METHODS: As part of the Randomized On/Off Bypass follow-up study, we followed 2,203 participants randomized to on-pump (n = 1,099) and off-pump (n = 1,104) CABG for 5 years using Department of Veterans Affairs and Medicare administrative data. We examined annual costs through 5 years, standardized to 2016 dollars, using multivariate regression models, controlling for site and baseline patient factors. RESULTS: In the first year, including the CABG surgery, annual average costs were $66,599 (SE, $1,946) for the on-pump group and $70,552 (SE, $1,954) for the off-pump group. In years 2 to 5, average costs ranged from $15,000 to $20,000 per year. There was no significant difference between on-pump and off-pump across the 5 years. We explored differences among high-risk subgroups (diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular disease, renal dysfunction, ejection fraction < 35%, over age 70 years), and found no treatment assignment by time interactions, except for a nonsignificant trend in patients with diabetes. CONCLUSIONS: At 5 years, the average costs of off-pump and on-pump CABG patients did not statistically differ. Costs do not favor one approach and the decision should be based on clinical risks, especially in subgroups. Future research is warranted to examine post-CABG costs and outcomes for diabeticpatients over time.
Authors: Todd H Wagner; Brack Hattler; Eileen M Stock; Kousick Biswas; Deepak L Bhatt; Faisal G Bakaeen; Kritee Gujral; Marco A Zenati Journal: JAMA Netw Open Date: 2022-06-01