Cost-effectiveness of minimally invasive cardiac operations

Background: Minimally invasive cardiac operations (MICOs) are reported to r educe procedural costs while at the same time decreasing operative morbidit y and improving patient comfort. However, most of the cost data available f or minimally invasive cardiac procedures is limited to short-term, peri-pro cedure, in-hospital costs. The scarcity of data to support claims for long- term cost-effectiveness prompted our interest in pursuing this research. Methods: Cost-effectiveness analysis was used to estimate the monetary cost required to achieve a gain in health benefit. We reviewed the literature t o accumulate all available relevant cost data regarding MICO in order to ap ply the principles of cost-effectiveness analysis to this relatively new pr ocedure. For purposes of the analysis, two assumptions were made: (1) MICOs have a less favorable long-term survival outcome than does conventional co ronary artery bypass grafting using cardiopulmonary bypass (CABG), and (2) the reintervention rates and long-term costs resulting from MICOs are simil ar to those of percutaneous transluminal coronary angioplasty with intracor onary stenting (PTCA/stenting). Results: The average procedural costs from published literature were $13,78 2 for PTCA/stenting, $16,082 for MICO, and $23,938 for CABG. The cost-effec tiveness of CABG and MICO were compared using PTCA/stenting as a standard o f comparison. These estimations suggest that MICO is less cost-effective th an CABG ($112,200 per year of life saved by MICO and $56,280 per year of li fe saved by CABG). Conclusions: Usable data to provide accurate cost-effectiveness estimates f or MICO is scarce. Preliminary estimates based on available data suggest tw o means of improving the cost-effectiveness of MICO. First, technical advan ces that improve the quality of MICO (e.g., improved patency rates for mamm ary anastomoses and complete revascularization strategies) will decrease th e reintervention rates and out-of-hospital costs. Second, application of MI CO to a high-risk subset of patients who will experience improved survival compared to other alternatives will improve cost-effectiveness by prolongin g life for those patients. Therefore, in order to be cost-effective, MICOs must obtain high quality results, including complete revascularization, and must be used primarily in high-risk patients.