2，500 in follow-up costs over the next year， mostly because of additional heart procedures and the need for long-term anti-clotting medication.
A formal cost-effectiveness analysis found that for the population as a whole， the clinical benefits of CABG did not justify its higher cost at one year. However， the complexity of coronary disease – determined by such factors as where the plaque was located， the number of lesions to treat， the length of lesions and whether they were calcified or layered with fragile blood clots – had a substantial influence on cost-effectiveness. In straightforward three-vessel or left main coronary disease， PCI led to better quality-adjusted life expectancy than CABG and lower healthcare costs. Findings were similar for patients with disease of intermediate complexity. However， for patients with complex three-vessel disease， quality-adjusted life expectancy was better with CABG， while overall costs at one year were nearly identical for the two procedures.
“The most important message is that there is no single answer. The relative cost-effectiveness of PCI and CABG for left main and three-vessel disease depends strongly on the complexity of underlying coronary disease，” Cohen said. “It is also important to note that our analysis applies only to the U.S. healthcare system. Given differences in treatment patterns and resource costs， the specific balance of costs and effectiveness may be very different in other countries.”
Five-year follow-up is planned for all patients in the SYNTAX trial.
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