alexa Long-term Cost-effectiveness of Endoscopic vs Open Vein Harvest for Coronary Artery Bypass Grafting
ISSN: 2329-9517

Journal of Cardiovascular Diseases & Diagnosis
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Research Article

Long-term Cost-effectiveness of Endoscopic vs Open Vein Harvest for Coronary Artery Bypass Grafting

Lars Oddershede1,2, Lars Holgers Ehlers and Jan Jesper Andreasen 2*
1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark
2Departments of Cardiothoracic Surgery and Clinical Medicine, Aalborg University Hospital, Denmark
Corresponding Author : Jan Jesper Andreasen
Departments of Cardiothoracic
Surgery and Clinical Medicine
Aalborg University Hospital, Hobrovej 18-22
DK-9000 Aalborg, Denmark
Tel: +45 97664651
E-mail: [email protected]
Received March 10, 2015; Accepted April 10, 2015; Published April 13, 2015
Citation: Oddershede L, Ehlers L, Andreasen JJ (2015) Long-term Cost-effectiveness of Endoscopic vs Open Vein Harvest for Coronary Artery Bypass Grafting. J Cardiovasc Dis Diagn 3:195. doi: 10.4172/2329-9517.1000195
Copyright: ©2015 Oddershede L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Background: The greater saphenous vein is frequently used as a conduit for coronary artery bypass grafting (CABG). Previously, veins were most often harvested using open vein harvesting (OVH), however, endoscopic vein harvesting (EVH) techniques have become increasingly popular. Nevertheless, the long-term cost-effectiveness of EVH remains unknown. The present study estimated the long-term cost-effectiveness of EVH versus OVH for CABG. Methods: A Markov model was developed to estimate life-time costs (UK Pounds Sterling) and quality adjusted life-years (QALYs) with comparative results presented as incremental cost-effectiveness ratios (ICERs). Costs and probabilities of events in the OVH group were mainly drawn from a previously published study. Resource consumption and event probabilities in the EVH group were estimated using a meta-analysis to reflect the best available evidence. Parameter uncertainty was assessed using both one-way sensitivity analyses and probabilistic sensitivity analyses. Results: The life-time cost/QALY was £8219 rendering EVH cost-effective compared to OVH. Sensitivity analyses showed that EVH was cost-effective in 60.4% of simulations at a threshold of £30 000/QALY, reflecting a large uncertainty in the point estimate of the ICER. The main causes of uncertainty were the time-horizon and the event rates of major clinical events in the treatment groups. Conclusions: Current evidence indicates that EVH is cost-effective for harvesting saphenous vein segments for CABG compared to OVH. Further studies on long-term clinical outcomes are needed to reach a more precise costeffectiveness estimate.

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