Economic evaluation of endoscopic versus open vein harvest for coronary artery bypass grafting

Background: A short saphenous vein segment is commonly used as a conduit for coronary artery bypass grafting, and clinicians must decide whether to obtain it by performing open (OVH) or endoscopic vein harvest (EVH). We conducted a health economic evaluation, using data on resource usage collected alongside a randomized controlled trial, to investigate whether EVH is cost-effective compared with OVH. Methods: Analyses were performed in accordance with international guidelines for health economic evaluations. We constructed 3 cost-levels as the current literature is inconclusive as to which resource consumptions differ significantly between harvesting methods. Outcomes were measured as purulent infections avoided in the cost-effectiveness analysis and for the cost-utility analysis we estimated quality-adjusted life-years gained. Results were presented as incremental cost-effectiveness ratios: ie, the extra cost of obtaining one extra quality-adjusted life-year and the extra cost of avoiding one purulent infection. To handle uncertainties, we performed bias corrected bootstrap analyses on 5,000 resamples and constructed cost-effectiveness acceptability curves. Results: The incremental cost-effectiveness ratio was $79,391/quality-adjusted life-year and $1,970/purulent infection avoided when costs and outcomes within 35 days postoperatively were compared. Within 35 days postoperatively, EVH was less than 1% cost-effective at a willingness-to-pay threshold of $50,000/quality- adjusted life-year. Conclusions: The EVH was not cost-effective within 35 days postoperatively. Future studies should investigate long-term cost effectiveness.