Optimal medical therapy more cost-effective than OMT paired with PCI

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“Compared with optimal medical therapy (OMT), percutaneous coronary intervention (PCI) plus OMT as a first choice of therapy for stable coronary artery disease is not cost effective,” according to William Weintraub, MD, author of the study, chair of cardiology and director of the Christiana Center for Outcomes Research in Newark, Del. Weintraub made his presentation at the American Heart Association (AHA) Scientific Sessions late-breaking sessions held in Orlando, Fla., last week.

Weintraub and colleagues examined the results of the Clinical Trial Outcomes Using Revascularization and Aggressive Drug Evaluation (COURAGE) trial.

The trial consisted of 2,287 patients randomized to PCI and OMT compared to OMT alone with a mean follow-up of 4.6 years. There was intensive, guideline-driven medical therapy and lifestyle intervention in both groups. The primary outcomes for the trial were death and myocardial infarction (MI), and the secondary outcome included healthcare economics.

Incremental cost-effective analysis demonstrated that PCI was associated with a cost of $288,474 per quality-adjusted life year gained. The cost was approximately $10,000 more than OMT, which includes the pharmacologic therapy and lifestyle interventions. The additional expense was incurred without any significant gain in quality-adjusted life years.

After his presentation, Weintraub said that healthcare economics are “not normally distributed.”

Weintraub concluded that his results found that PCI is not an effective initial management strategy, and does not prolong life. He also said that PCI and OMT are more expensive than OMT alone, and not cost-effective.

Raymond Gibbons, MD, immediate past president of the AHA and professor of medicine and co-director of the nuclear cardiology lab at the Mayo Clinic in Rochester, Minn., moderated the session. He said patients “undergoing OMT are more likely to undergo surgery, which is tremendously expensive and could have presented high unforeseen costs.”

As a result, Gibbons and Weintraub agreed that the results were not predictable.