From the Guidelines
The cost per quality-adjusted life year (QALY) for coronary artery bypass grafting (CABG) is generally considered to be between $20,000 to $60,000, making it a cost-effective option for patients with severe coronary artery disease, as supported by the most recent evidence 1.
Cost-Effectiveness of CABG
The cost-effectiveness of CABG varies significantly based on patient characteristics, with CABG being more economically favorable for patients with more severe coronary artery disease, particularly those with left main disease or three-vessel disease.
- The initial procedure is expensive, costing between $30,000 and $200,000 depending on the country, hospital, complications, and length of stay.
- However, CABG provides substantial long-term benefits including improved survival rates and quality of life, which offset the high initial costs when calculated over a patient's lifetime.
- The economic value of CABG also compares favorably to percutaneous coronary intervention (PCI) for complex coronary disease, especially when considering the lower rate of repeat procedures needed after CABG, as seen in studies such as the BARI 2D study which found CABG to be cost-effective at $47,000 per life-year added 1.
Comparison to Other Interventions
- In comparison to PCI, CABG has been shown to be more cost-effective in certain patient populations, such as those with three-vessel disease.
- The FAME-2 trial found the incremental cost-effectiveness ratio of PCI to be $36,000 per QALY, which is higher than the cost-effectiveness ratio of CABG 1.
- Decision support tools are needed to assess procedural risk and educate patients about the probability of death or MI and improved QoL with or without PCI or CABG, as patients are often not truly knowledgeable after receiving “informed consent” for elective PCI 1.
From the Research
Cost-Effectiveness of CABG
- The cost-effectiveness of Coronary Artery Bypass Grafting (CABG) has been evaluated in several studies, with varying results 2, 3, 4.
- A study published in the Journal of the American Heart Association found that the incremental cost-effectiveness ratio of CABG versus Percutaneous Coronary Intervention (PCI) was $101,565 per quality-adjusted life-year (QALY) gained 2.
- Another study published in Artificial Organs found that the mean total cost of CABG without cardiopulmonary bypass was £5,859, compared to £7,431 for CABG with cardiopulmonary bypass, with no significant difference in QALYs gained between the two groups 3.
- A study published in the International Journal of Cardiology found that the incremental cost-effectiveness ratio of on-pump CABG versus off-pump CABG was $12,576 per QALY gained, which is above the suggested cost-effectiveness threshold range 4.
Quality-Adjusted Life Years (QALYs)
- The QALYs gained with CABG have been reported to vary depending on the study and the comparison group 2, 3, 4.
- A study published in the Journal of the American Heart Association found that CABG was associated with a gain of 0.93 QALYs compared to PCI 2.
- Another study published in Artificial Organs found that the mean QALYs gained over 6 months was 0.379 in the off-pump CABG group and 0.362 in the on-pump CABG group, with no significant difference between the two groups 3.
Cost-Effectiveness Threshold
- The cost-effectiveness threshold for CABG has been reported to vary depending on the study and the comparison group 2, 4.
- A study published in the International Journal of Cardiology found that the incremental cost-effectiveness ratio of on-pump CABG versus off-pump CABG was above the suggested cost-effectiveness threshold range of $3,210 to $10,122 per QALY gained 4.