5-Year Comparative cost-effectiveness analysis of CABG Surgery and PCI with Second-Generation Drug-Eluting Stents in Elderly Patients with Type 2 Diabetes: A Single-Center Real-World Evidence

Biological & Medical Sciences

ABSTRACT Elderly individuals diagnosed with type 2 diabetes mellitus (T2DM) represent a unique, high -cost group within cardiology, primarily due to their complex anatomical considerations and increased burden of comorbidities. The decision-making process regarding coronary artery bypass grafting (CABG) and second-generation drug-eluting stent percutaneous coronary intervention (DES-PCI) has significant implications for both patient outcomes and resource allocation. This study aims to conduct a comprehensive cost-effectiveness analysis, using CABG as the reference strategy, to evaluate second-generation DES-PCI in elderly patients with T2DM and coronary artery disease (CAD). This was a single-center retrospective cohort study conducted at the First Affiliated Hospital of Xinjiang Medical University, and included the revascularization of 400 elderly patients with T2DM. Considering the analysis of cost-effectiveness, a multivariable Generalized Linear Model was developed, and the base-case analysis and probabilistic sensitivity analyses were performed. The total cost per patient was $20,287 for the CABG strategy and $6,749 for the second-generation DES-PCI strategy. Choosing CABG over DES-PCI resulted in an incremental cost of $13,538 (95% CI: [$11,039 to $16,343]). The incremental effectiveness was 0.556 MACCE-free Lys. Consequently, the ICER for the CABG strategy versus the DES-PCI strategy was $24,349 (95% CI: [$19,976 to $29,275]) per MACCE-free LY gained. The CABG revascularization strategy represents a cost-effective intervention compared to second generation DES-PCI at a WTP threshold of 39,909 USD per MACCE-free LY. The findings indicate that, from a health economic perspective, the higher initial investment in CABG is supported by the significant long-term health benefit it provides in terms of event-free survival.

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.