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

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.