Appropriate treatment decision for coronary artery diseases has not been fully established yet, although several clinical trials have been done. The most important issue is that a long-term follow-up study is greatly lacking. In this study, based on a long-term cohort study, the efficacy and efficiency of medical treatment (MED), percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) in Japan were evaluated.Method - To estimate the costs and benefits of 12 years follow-up, simulation model based on Weibull function was developed. Data were obt
ained from Japanese cohort study during 1973-1984. The study criterion was patients with significant stenoses (> or = 75% occlusion). In the analysis, MED and PTCA were compared in single vessel disease (SVD) with left ventricular ejection fraction > or = 60%, PTCA and CABG were compared in double and triple vessel disease (DVD, TVD) with multi vessel interventions. An economic analysis was performed for 50 aged patients from a societal viewpoint. Both costs and benefits were discounted by 5% annually.Results - In SVD, the incremental cost-effectiveness ratio (CE) of MED was -$25380. The incremental cost-utility ratio (CU) of PTCA was $60500. In DVD, the CE of PTCA was -$5960, and the CU of CABG was $27150. In TVD, the CE of PTCA was -$25820, and the CU of CABG was $1380.Conclusions - The results showed that MED is dominant in SVD. PTCA is dominant in CE of both DVD and TVD, while CABG is cost effective in CU of TVD. Since this study is based on a cohort study, further studies will require
ained from Japanese cohort study during 1973-1984. The study criterion was patients with significant stenoses (> or = 75% occlusion). In the analysis, MED and PTCA were compared in single vessel disease (SVD) with left ventricular ejection fraction > or = 60%, PTCA and CABG were compared in double and triple vessel disease (DVD, TVD) with multi vessel interventions. An economic analysis was performed for 50 aged patients from a societal viewpoint. Both costs and benefits were discounted by 5% annually.Results - In SVD, the incremental cost-effectiveness ratio (CE) of MED was -$25380. The incremental cost-utility ratio (CU) of PTCA was $60500. In DVD, the CE of PTCA was -$5960, and the CU of CABG was $27150. In TVD, the CE of PTCA was -$25820, and the CU of CABG was $1380.Conclusions - The results showed that MED is dominant in SVD. PTCA is dominant in CE of both DVD and TVD, while CABG is cost effective in CU of TVD. Since this study is based on a cohort study, further studies will require
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