HEALTH-SERVICE COSTS OF CORONARY ANGIOPLASTY AND CORONARY-ARTERY BYPASS-SURGERY - THE RANDOMIZED INTERVENTION TREATMENT OF ANGINA (RITA) TRIAL

For some patients with coronary artery disease, percutaneous translumi nal coronary angioplasty (PTCA) is an alternative to coronary artery b ypass grafting (CABG). We report comparative health service costs of t hese interventions within the Randomised intervention Treatment of Ang ina (RITA) trial. Medications were costed at published UK prices; othe r resource use was costed with a set of unit costs estimated at two re cruiting centres to the RITA trial, one in London and one outside. Ove r 2-year follow-up of 1011 patients, the estimated mean additional cos t for those randomised to CABG compared with PTCA was pound 1050 (95% Cl pound 621-pound 1479),with unit costs from the non-London centre, a nd pound 1823 (pound 1202-pound 2444), with unit costs from the London centre. The initial average cost of treating a patient randomised to PTCA is about 52% of that of CABG, but after 2 years this increased to about 80% because of the greater need for subsequent interventions. T he balance of advantage between PTCA and CABG may change after several years: funding has been obtained to continue RITA follow-up for 10 ye ars. However, on the basis of patients' status at 2 years, the cost ad vantages of PTCA cannot be ignored. Further research is necessary to a ssess whether the advantage of PTCA in terms of cost is translated int o one of cost-effectiveness.