Medical costs and quality of life 10 to 12 years after randomization to angioplasty or bypass surgery for multivessel coronary artery disease

Circulation. 2004 Oct 5;110(14):1960-6. doi: 10.1161/01.CIR.0000143379.26342.5C. Epub 2004 Sep 27.


Background: Coronary bypass surgery (CABG) and angioplasty (PTCA) have been compared in several randomized trials, but data about long-term economic and quality-of-life outcomes are limited.

Methods and results: Cost and quality-of-life data were collected prospectively from 934 patients who were randomized in the Bypass Angioplasty Revascularization Investigation (BARI) and followed up for 10 to 12 years. CABG had 53% higher costs initially, but the gap closed to <5% during the first 2 years; after 12 years, the mean cumulative cost of CABG patients was 123,000 dollars versus 120,750 dollars for PTCA, yielding a cost-effectiveness ratio of 14,300 dollars/life-year added. CABG patients experienced significantly greater improvement in their physical functioning for the first 3 years but not in later follow-up. Recurrent angina substantially reduced all quality-of-life measures throughout follow-up. Cumulative costs were significantly higher among patients with diabetes, heart failure, and comorbid conditions and among women; costs also were increased by angina, by the number of revascularization procedures, and among patients who died.

Conclusions: Early differences between CABG and PTCA in costs and quality of life were no longer significant at 10 to 12 years of follow-up. CABG was cost-effective as compared with PTCA for multivessel disease.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Angina Pectoris / epidemiology
  • Angioplasty, Balloon, Coronary / economics
  • Angioplasty, Balloon, Coronary / psychology
  • Angioplasty, Balloon, Coronary / statistics & numerical data*
  • Comorbidity
  • Coronary Artery Bypass / economics
  • Coronary Artery Bypass / psychology
  • Coronary Artery Bypass / statistics & numerical data*
  • Coronary Disease / economics
  • Coronary Disease / psychology
  • Coronary Disease / surgery
  • Coronary Disease / therapy*
  • Coronary Restenosis / epidemiology
  • Cost-Benefit Analysis
  • Disease Progression
  • Employment / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Graft Survival
  • Health Care Costs*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Recovery of Function
  • Survival Analysis