Treatment for stable coronary artery disease: a network meta-analysis of cost-effectiveness studies

PLoS One. 2014 Jun 4;9(6):e98371. doi: 10.1371/journal.pone.0098371. eCollection 2014.

Abstract

Introduction and objectives: Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG).

Methods: RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs.

Results: Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3-year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG.

Conclusions: Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina.

Publication types

  • Meta-Analysis

MeSH terms

  • Coronary Artery Bypass / economics*
  • Coronary Artery Disease / economics
  • Coronary Artery Disease / surgery*
  • Cost-Benefit Analysis
  • Drug-Eluting Stents / economics*
  • Humans
  • Percutaneous Coronary Intervention / economics*

Grants and funding

The authors have no support or funding to report.