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OBJECTIVE: To compare cost - effectiveness and length of hospitalisation between TECAB, MIDCAB, and conventional sternotomy CABG.
METHODS: Preoperative and postoperative data of patients undergoing TECAB, MIDCAB and conventional sternotomy CABG were collected in a prospective database. Health quality adjusted life years (QALY) were calculated from SF-36 questionnaires collected at 0, 1, 3, and 6 months. Cost data was obtained from previous published manuscripts. Incremental cost effectiveness ratio (ICER) was calculated by diving increment of cost of TECAB by increment in QALY when compared to CABG. Mann-Whitney U test was used and results are compared by median and range values with statistical significance at p<0.05.
RESULTS: There was a significant benefit of totally endoscopic procedures among conventional CABG in length of primary (8 days (5-25 days) vs 7(2-33), p<0.001) and secondary hospitalisation (7(1-14) vs 0(0-49), p<0.001). Length of stay at rehabilitation (21(0-29) vs 28(0-42), p=0.691) as well as total institutionalisation (39(10-50) vs 34(4-83), p=0.350) were not significant between the groups.
TECAB group had a significantly higher QALY gained at 6 months after procedure when compared to MIDCAB (0.370(+/-0.041) vs 0.358(+/-0.030), p=0.029) and a trend towards higher QALY gained when compared to CABG (0.370(+/-0.041) vs 0.357(+/-0.036), p=0.068).
For conventional CABG the cost per QALY gained was $333,840 and for TECAB it was $263,849. In addition, we calculated incremental cost effectiveness ratio (ICER) comparing conventional CABG to TECAB. The TECAB had higher QALY and lower cost of the procedure resulting in the ICER of $-1,658,231.
CONCLUSIONS: All in all, we demonstrated a reduction in hospitalisation time with a trend in QALY gained at 6 months after procedure using totally endoscopic techniques when compared to CABG. TECAB was associated with a significant reduction in costs per QALY gained.