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eComment: Costs of percutaneous coronary intervention versus coronaryartery bypass surgery

UNIOESTE, Paranas' West State University, Rua Terra Roxa 1425, Cascavel, PR 85816-360, Brazil

Percutaneous coronary intervention versus coronary artery bypass surgery in multivessel disease: a current perspective

I read with great interest the recent report by Dr. Soran and coworkers regarding the current perspective of treating multivessel coronary disease [1]. Despite the fact that the authors brought into perspective a new way of analyzing the different groups that form the multivessel coronary artery disease, one point that struck me is the analysis of the cost-effectiveness of coronary artery bypass surgery (CABG) versus percutaneous coronary intervention (PCI). This seems to become a main issue for the years to come, especially in relation to governmental health services.

In 2005 we published, in Brazil, a prospective study comparing costs of CABG vs. PCI for a period of six months, in one institution which at that time used bare (70.5%) and drug-eluting stents (29.5%) – http://www.rbccv.org.br/detalhe_artigo_ingles.asp?id=457 [2]. These groups were followed for a period of 12 months for re-interventions and costs. All costs were calculated in Brazilian Reais.

The results showed that despite the fact that the initial costs were higher for CABG at the end of the follow-up period, this relation was inverted for the PCI group which was higher by 4.4% at the end of a year. In the subgroup using drug eluting stents the costs were 17.4% higher at the end of the same period. With the cost increase of stents and still a high rate of re-intervention in the PCI group, it seems that the five-year assessment of this group of patients will continue to trend higher.

	References

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1. Soran O, Manchanda A, Schueler S. Percutaneous coronary intervention versus coronary artery bypass surgery in multivessel disease: a currentperspective. Interact CardioVasc Thorac Surg 2009;8:666–672.[Abstract/Free Full Text]
2. Almeida RMS. Myocardial revascularization: comparative cost study between conventional coronary bypass and percutaneous transluminalcoronary angioplasty. Rev Bras Cir Cardiovasc 2005;20:142–148.

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