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On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial.

Publication ,  Conference
Wagner, TH; Hattler, B; Bishawi, M; Baltz, JH; Collins, JF; Quin, JA; Grover, FL; Shroyer, ALW; VA #517 Randomized On/Off Bypass (ROOBY) Study Group,
Published in: The Annals of thoracic surgery
September 2013

Questions have been raised about the costs and outcomes for patients receiving on-pump and off-pump coronary artery bypass graft surgery. As part of the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) multisite trial, a cost-effectiveness analysis was performed to compare on-pump versus off-pump patients' quality-adjusted life-years and costs at 1 year.One-year outcomes and costs (standardized to 2010 dollars) were estimated in multivariate regression models, controlling for site and baseline patient factors. The 1-year incremental cost-effectiveness analysis ratio with 95% confidence intervals was calculated using bootstrapping.Eighteen centers randomly assigned 2,203 participants to on-pump (n=1,099) versus off-pump (n=1,104) coronary artery bypass graft surgery. Both groups' quality of life improved significantly after surgery (p<0.01) compared with baseline, but no differences were found between treatment groups. Adjusted cost of the index coronary artery bypass graft surgery hospitalization was $36,046 on-pump and $36,536 off-pump (p=0.16). At 1 year, on-pump adjusted cost was $56,023 versus $59,623 off-pump (p=0.046). Off-pump-to-on-pump conversions after first distal anastomosis (4.8%) had significantly higher 1-year costs. Excluding conversions, there were no significant differences between treatments for index hospitalization or 1-year total costs.At 1 year, off-pump coronary artery bypass graft surgery was more expensive than on-pump when late off-pump-to-on-pump conversions were included. Excluding late conversions, there was no difference in quality-adjusted life-years or costs.ClinicalTrials.gov identifier NCT00032630; http://clinicaltrials.gov/ct2/show/NCT00032630.

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Published In

The Annals of thoracic surgery

DOI

EISSN

1552-6259

ISSN

0003-4975

Publication Date

September 2013

Volume

96

Issue

3

Start / End Page

770 / 777

Related Subject Headings

  • United States
  • Risk Assessment
  • Respiratory System
  • Regression Analysis
  • Quality-Adjusted Life Years
  • Middle Aged
  • Male
  • Humans
  • Health Care Costs
  • Female
 

Citation

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ICMJE
MLA
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Wagner, T. H., Hattler, B., Bishawi, M., Baltz, J. H., Collins, J. F., Quin, J. A., … VA #517 Randomized On/Off Bypass (ROOBY) Study Group, . (2013). On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial. In The Annals of thoracic surgery (Vol. 96, pp. 770–777). https://doi.org/10.1016/j.athoracsur.2013.04.074
Wagner, Todd H., Brack Hattler, Muath Bishawi, Janet H. Baltz, Joseph F. Collins, Jacquelyn A. Quin, Frederick L. Grover, A Laurie W. Shroyer, and A Laurie W. VA #517 Randomized On/Off Bypass (ROOBY) Study Group. “On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial.” In The Annals of Thoracic Surgery, 96:770–77, 2013. https://doi.org/10.1016/j.athoracsur.2013.04.074.
Wagner TH, Hattler B, Bishawi M, Baltz JH, Collins JF, Quin JA, et al. On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial. In: The Annals of thoracic surgery. 2013. p. 770–7.
Wagner, Todd H., et al. “On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial.The Annals of Thoracic Surgery, vol. 96, no. 3, 2013, pp. 770–77. Epmc, doi:10.1016/j.athoracsur.2013.04.074.
Wagner TH, Hattler B, Bishawi M, Baltz JH, Collins JF, Quin JA, Grover FL, Shroyer ALW, VA #517 Randomized On/Off Bypass (ROOBY) Study Group. On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial. The Annals of thoracic surgery. 2013. p. 770–777.
Journal cover image

Published In

The Annals of thoracic surgery

DOI

EISSN

1552-6259

ISSN

0003-4975

Publication Date

September 2013

Volume

96

Issue

3

Start / End Page

770 / 777

Related Subject Headings

  • United States
  • Risk Assessment
  • Respiratory System
  • Regression Analysis
  • Quality-Adjusted Life Years
  • Middle Aged
  • Male
  • Humans
  • Health Care Costs
  • Female