Long-term clinical outcomes, health-related quality of life, and costs in different treatment modalities of stable coronary artery disease

Eur Heart J Qual Care Clin Outcomes. 2017 Jan 1;3(1):74-82. doi: 10.1093/ehjqcco/qcw024.


Aims: This study is a prospective, observational 8-year follow-up of 300 stable unselected coronary artery disease patients entering elective coronary angiography in 2002-03. Recorded were clinical outcomes, health-related quality of life (HRQoL), and secondary care costs after coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), or medical therapy (MT).

Methods and results: HRQoL was measured by the 15D instrument at baseline, 6 months, and 8 years. Regression techniques with an adjustment for relevant baseline characteristics were used to compare the 8-year survival and change in HRQoL between the groups. At baseline, all groups had statistically significantly impaired HRQoL compared with age- and gender-standardized general population. Six months after invasive interventions the mean HRQoL score had improved in a statistically significant and clinically important manner. This improvement was maintained at 8 years as the HRQoL no longer differed from that of the general population, whereas MT patients were still worse off. However, after adjustment for baseline characteristics, the groups no longer differed regarding 8-year survival or change in HRQoL among survivors. Mean 8-year secondary care costs were without (with) adjustment for baseline characteristics: €17 498 (16 730) for CABG, €7245 (6920) for PCI, and €4514 (4580) for MT, respectively.

Conclusion: When adjusted for baseline characteristics, no statistically significant differences were found between the patient groups in 8-year survival or change in HRQoL among survivors. The 8-year mean secondary care costs of CABG were over two-fold and almost four-fold, even after adjustment for baseline characteristics, compared with those of PCI and MT.

Keywords: Coronary artery bypass grafting; Coronary artery disease; Cost utility; Health-related quality of life; Percutaneous coronary intervention.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Coronary Artery Disease / economics
  • Coronary Artery Disease / psychology
  • Coronary Artery Disease / therapy*
  • Cost-Benefit Analysis
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myocardial Revascularization / economics
  • Myocardial Revascularization / methods*
  • Prospective Studies
  • Quality of Life*
  • Quality-Adjusted Life Years
  • Surveys and Questionnaires
  • Thrombolytic Therapy / economics
  • Thrombolytic Therapy / methods*
  • Time Factors
  • Treatment Outcome