The Cost Implications of Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery at One Year

Lamy, André; Tong, Wesley; Devereaux, P. J.; Gao, Peggy; Gafni, Amiram; Singh, Kavita; Taggart, David P.; Straka, Z.; Akar, Ahmet; Piegas, Leopoldo Soares; Ou, Yongning; Yusuf, Salim

doi:10.1016/j.athoracsur.2014.06.046

Cited by 26 publications

(14 citation statements)

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“…A cost-effect study (CORONARY trial) demonstrated that OPCAB was clinically as safe and effective as on-pump CABG, with no difference in cost. Thus, the decision as to which method to choose should be free from cost considerations and should be based on patient preference and surgeon expertise (33). The study did find, however, that as the costs of some surgical ancillary materials were much different in various countries, the average hospital expense might be different when the patient received OPCAB.…”

Section: Opcab and On-pump Cabg On Patient's Quality Of Life And Finamentioning

confidence: 62%

On- or Off-Pump Coronary Artery Bypass: What Is the Evidence?

Sun¹,

Peng²

2016

J Anesth Perioper Med

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Section: Opcab and On-pump Cabg On Patient's Quality Of Life And Finamentioning

confidence: 62%

On- or Off-Pump Coronary Artery Bypass: What Is the Evidence?

Sun¹,

Peng²

2016

J Anesth Perioper Med

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“…Thus, while onpump and off-pump techniques appear to have similar clinical outcomes, could one technique prove more effective through lower overall costs? Lamy and colleagues [4] begin to address this question in their current analysis and demonstrate that after 1 year there was no significant difference in total cost per patient between onpump and off-pump groups.…”

Section: Invited Commentarymentioning

confidence: 80%

Invited Commentary

Alexander¹

2014

The Annals of Thoracic Surgery

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The 1-year outcomes of the CORONARY trial were published this past year and demonstrated no significant difference between on-pump and off-pump coronary artery bypass grafting (CABG) with regard to the primary composite endpoint or rate of repeat coronary revascularization. Combined with the recent outcomes of the GOPCABGE study [German Off-Pump Coronary Artery Bypass Grafting in Elderly Patients] demonstrating no difference in on-pump or off-pump CABG in elderly patients, much of the large, contemporary literature on off-pump CABG indicates that, unlike the results of the ROOBY [Randomized On/Off Bypass] trial, off-pump is at least noninferior to on-pump CABG [1,2].In this growing era of comparative effectiveness research, however, we see a trend toward assessing new technologies not only with regard to their clinical effectiveness but also cost effectiveness [3]. Thus, while onpump and off-pump techniques appear to have similar clinical outcomes, could one technique prove more effective through lower overall costs? Lamy and colleagues [4] begin to address this question in their current analysis and demonstrate that after 1 year there was no significant difference in total cost per patient between onpump and off-pump groups.However, this analysis does have some notable limitations. The CORONARY trial recruited 4,752 patients from 79 centers and 19 countries. Variability exists among countries in event costs used to calculate health care utilization costs, and furthermore the conversion of such event costs to standardized US dollars using purchasing power parties relies on several significant economic assumptions. More importantly, the authors do not include the cost for surgical supplies in their analysis. The high costs associated with disposables such as retractors and stabilizers have the potential to significantly alter the conclusions of the study, as demonstrated by the authors' sensitivity analysis. While Lamy and colleagues [4] offer an important starting point for assessing the cost effectiveness of on-pump versus off-pump CABG, further research is necessary before drawing final conclusions. An ideal cost effectiveness analysis would be performed in 1 or more hospitals in the same country to limit economic assumptions, be high volume in both on-pump and off-pump techniques to eliminate operator bias, and account for differences in direct costs of surgical supplies such as disposables. References 1. Diegeler A, B€ orgermann J, Kappert U, et al. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med 2013;368:1189-98. 2. Shroyer AL, Grover FL, Hattler B, et al. On-pump versus offpump coronary-artery bypass surgery. N Engl

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“…In contrast, data from the CORONARY trial showed no difference in costs between the 2 techniques 115. During the index hospitalization, the cost for patients undergoing OPCAB was $8626 compared with $8567 for ONCAB, with a nonsignificant difference of $59.…”

Section: Comparison Of Hospital Costs Between Off‐ and On‐pump Cabgmentioning

confidence: 83%

“…This finding was also confirmed by a large retrospective study (63 000 patients)113 in which multivariable regression analysis showed a higher final cost by $1497 per patient in those treated by OPCAB ( P <0.001). Factors influencing the final cost of off‐pump surgery were age >65 years, number of grafts, duration of anesthesia, very low EF, and low to medium hospital OPCAB volume 115, 118. Interestingly, no difference in cost was found in the CORONARY trial118 among the different geographic areas for ONCAB and OPCAB 115…”

Section: Comparison Of Hospital Costs Between Off‐ and On‐pump Cabgmentioning

confidence: 99%

“…Factors influencing the final cost of off‐pump surgery were age >65 years, number of grafts, duration of anesthesia, very low EF, and low to medium hospital OPCAB volume 115, 118. Interestingly, no difference in cost was found in the CORONARY trial118 among the different geographic areas for ONCAB and OPCAB 115…”

Section: Comparison Of Hospital Costs Between Off‐ and On‐pump Cabgmentioning

confidence: 99%

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