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Scudeler TL, Hueb WA, Farkouh ME, Maron DJ, de Soárez PC, Campolina AG, Takiuti ME, Rezende PC, Godoy LC, Hueb AC, Lima EG, Garzillo CL, Ramires JAF, Kalil Filho R. Cost-effectiveness of on-pump and off-pump coronary artery bypass grafting for patients with coronary artery disease: Results from the MASS III trial. Int J Cardiol 2018; 273:63-68. [DOI: 10.1016/j.ijcard.2018.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 11/25/2022]
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Brandão SMG, Rezende PC, Rocca HPBL, Ju YT, de Lima ACP, Takiuti ME, Hueb W, Bocchi EA. Comparative cost-effectiveness of surgery, angioplasty, or medical therapy in patients with multivessel coronary artery disease: MASS II trial. Cost Eff Resour Alloc 2018; 16:55. [PMID: 30410425 PMCID: PMC6215652 DOI: 10.1186/s12962-018-0158-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/24/2018] [Indexed: 02/08/2023] Open
Abstract
Background The costs for treating coronary artery disease (CAD) are high worldwide. We performed a prespecified analyses of cost-effectiveness of three therapeutic strategies for multivessel CAD. Methods From May 1995 to May 2000, a total of 611 patients were randomly assigned to coronary artery bypass graft (CABG), n = 203; percutaneous coronary intervention (PCI), n = 205; or medical treatment (MT), n = 203. This cost analysis study was based on the perspective of the Public Health Care System. Initial procedural and follow-up costs for medications, cardiology examinations, and hospitalizations for complications were calculated after randomization. Life-years and quality-adjusted life years (QALYs) were used as effectiveness measures. Incremental cost-effectiveness ratios (ICER) were obtained by using nonparametric bootstrapping methods with 5000 resamples. Results Initial procedural costs were lower for MT. However, the subsequent 5-year cumulative costs were lower for CABG. Compared with baseline, the three treatment options produced significant improvements in QALYs. After 5 years, PCI and CABG had better QALYs results compared with MT. The ICER results favored CABG and PCI, and favored PCI over CABG in 61% of the drawings. On the other hand, sensitivity analysis showed MT as the preferred therapy compared with CABG and PCI, in the analysis considering higher costs. Conclusions At 5-year follow-up, the three treatment options yielded improvements in quality of life, with comparable and acceptable costs. However, despite higher initial costs, the comparison of cost-effectiveness after 5 years of follow-up among the three treatments showed both interventions (CABG and PCI) to be cost-effective strategies compared with MT.Trial registration ISRCTN, ISRCTN66068876, Registered 06/10/1994, http://www.controlled-trials.com/ISRCTN66068876.
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Affiliation(s)
- Sara Michelly Gonçalves Brandão
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
| | - Paulo Cury Rezende
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
| | - Hans-Peter Brunner-La Rocca
- 2Heart Failure Clinic, Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yang Ting Ju
- 3Department of Statistics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, SP Brazil
| | | | - Myrthes Emy Takiuti
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
| | - Whady Hueb
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
| | - Edimar Alcides Bocchi
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
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Scudeler TL, Hueb W, De Soarez PC, Campolina AG, Hueb AC, Rezende PC, Lima EG, Garzillo CL, Ribas FF, Takiuti ME, Ramires JAF, Kalil Filho R. P2657Cost-effectiveness analysis of on-pump and off-pump coronary artery bypass grafting for patients with multivesselcoronary artery disease: a Markov model based on data from the MASS III trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T L Scudeler
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W Hueb
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | | | - A G Campolina
- University of Sao Paulo, Cancer Institute, Sao Paulo, Brazil
| | - A C Hueb
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - P C Rezende
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C L Garzillo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - F F Ribas
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - M E Takiuti
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J A F Ramires
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
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Brandão SMG, Hueb W, Ju YT, de Lima ACP, Polanczyk CA, Cruz LN, Garcia RMR, Takiuti ME, Bocchi EA. Utility and quality-adjusted life-years in coronary artery disease: Five-year follow-up of the MASS II trial. Medicine (Baltimore) 2017; 96:e9113. [PMID: 29390308 PMCID: PMC5815720 DOI: 10.1097/md.0000000000009113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study evaluated the utility and quality-of-life year measurements for patients with coronary artery disease who underwent any of 3 therapeutic strategies with a 5-year follow-up. METHODS Quality-of-life data were obtained from the Medicine, Angioplasty, or Surgery Study II trial. To obtain utilities, the 36-Item Short-Form questionnaire was converted to a 6-Dimensional Health State Classification System. RESULTS Of the 611 initial patients, 579 completed the questionnaire. In all, 188 patients received the surgical treatment-194 the percutaneous, and the remaining 197 the medical. The median utility scores for the 5 years analyzed were 0.809 (95% confidence interval [CI] 0.794-0.842) for patients assigned to percutaneous coronary intervention, 0.755 (95% CI 0.723-0.774) for medical treatment, and 0.780 (95% CI 0.761-0.809) for coronary artery bypass graft surgery. The difference between percutaneous coronary intervention and medical treatment was statistically significant (P < .05, Dunn test). The median cumulative quality-of-life years across the 5 years were 3.802 (95% CI 3.668-3.936) for percutaneous, 3.540 (95% CI 3.399-3.681) for medical, and 3.764 (95% CI 3.638-3.890) for surgery. Additionally, the median quality-of-life years between percutaneous and medical treatment was 0.262 (95% CI 0.068-0.456), between surgery and medical treatment it was 0.224 (95% CI 0.036-0.413), and between surgery and percutaneous coronary intervention it was -0.038 (95% CI -0.221 to -0.146). CONCLUSION Coronary artery bypass surgery and percutaneous coronary intervention were similar regarding cumulative quality-of-life years; however, they were both superior to that of medical treatment. The results presented are valuable data for further cost-utility studies.
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Affiliation(s)
| | - Whady Hueb
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Yang Ting Ju
- Institute of Mathematics and Statistics, Department of Statistics, University of São Paulo, São Paulo, SP
| | | | - Carisi Anne Polanczyk
- Post Graduate Program in Cardiology and Cardiovascular Disease, Federal University of Rio Grande do Sul
- Instituto Nacional para Avaliação de Tecnologia em Saúde, IATS/CNPq, Porto Alegre, RS, Brazil
| | - Luciane Nascimento Cruz
- Instituto Nacional para Avaliação de Tecnologia em Saúde, IATS/CNPq, Porto Alegre, RS, Brazil
| | - Rosa Maria Rahmi Garcia
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | | | - Edimar Alcides Bocchi
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
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Hueb W, Gersh BJ, Alves da Costa LM, Costa Oikawa FT, Vieira de Melo RM, Rezende PC, Garzillo CL, Lima EG, Nomura CH, Villa AV, Hueb AC, Cassaro Strunz CM, Favarato D, Takiuti ME, de Albuquerque CP, Ribeiro da Silva EE, Franchini Ramires JA, Kalil Filho R. Accuracy of Myocardial Biomarkers in the Diagnosis of Myocardial Infarction After Revascularization as Assessed by Cardiac Resonance: The Medicine, Angioplasty, Surgery Study V (MASS-V) Trial. Ann Thorac Surg 2016; 101:2202-8. [PMID: 26912303 DOI: 10.1016/j.athoracsur.2015.11.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/14/2015] [Accepted: 11/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The lack of a correlation between myocardial necrosis biomarkers and electrocardiographic abnormalities after revascularization procedures has resulted in a change in the myocardial infarction (MI) definition. METHODS Patients with stable multivessel disease who underwent percutaneous or surgical revascularization were included. Electrocardiograms and concentrations of high-sensitive cardiac troponin I (cTnI) and creatine kinase (CK)-MB were assessed before and after procedures. Cardiac magnetic resonance and late gadolinium enhancement were performed before and after procedures. MI was defined as more than five times the 99th percentile upper reference limit for cTnI and 10 times for CK-MB in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), respectively, and new late gadolinium enhancement for cardiac magnetic resonance. RESULTS Of the 202 patients studied, 69 (34.1%) underwent on-pump CABG, 67 (33.2%) off-pump CABG, and 66 (32.7%) PCI. The receiver operating characteristic curve showed the accuracy of cTnI for on-pump CABG, off-pump CABG, and PCI patients was 21.7%, 28.3%, and 52.4% and for CK-MB was 72.5%, 81.2%, and 90.5%, respectively. The specificity of cTnI was 3.6%, 9.4%, and 42.1% and of CK-MB was 73.2%, 86.8%, and 96.4%, respectively. Sensitivity of cTnI was 100%, 100%, and 100% and of CK-MB was 69.2%, 64.3%, and 44.4%, respectively. The best cutoff of cTnI for on-pump CABG, off-pump CABG, and PCI was 6.5 ng/mL, 4.5 ng/mL, and 4.5 ng/mL (162.5, 112.5, and 112.5 times the 99th percentile upper reference limit) and of CK-MB was 37.5 ng/mL, 22.5 ng/mL, and 11.5 ng/mL (8.5, 5.1, and 2.6 times the 99th percentile upper reference limit), respectively. CONCLUSIONS Compared with cardiac magnetic resonance, CK-MB was more accurate than cTnI for diagnosing MI. These data suggest a higher troponin cutoff for the diagnosis of procedure-related MI.
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Affiliation(s)
- Whady Hueb
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
| | | | | | | | | | - Paulo Cury Rezende
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Cibele Larrosa Garzillo
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Eduardo Gomes Lima
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Cesar Higa Nomura
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Alexandre Volney Villa
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Alexandre Ciappina Hueb
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Celia Maria Cassaro Strunz
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Desiderio Favarato
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Myrthes Emy Takiuti
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Cicero Piva de Albuquerque
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | | | | | - Roberto Kalil Filho
- Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
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Segre C, Junior ANA, Nomura C, Villa A, Strunz C, Rezende P, Parga J, Takiuti ME, Hueb W, Ramires J, Kalil-Filho R. HIGH SENSITIVITY CARDIAC TROPONIN I CHANGES RELATED WITH T1 MAPPING IN PATIENTS WITH CHRONIC ISCHAEMIC HEART DISEASE WITHOUT LATE ENHANCEMENT GADOLINIUM BY CRM. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Takiuti ME, Hueb W, Hiscock SB, Nogueira CRSDR, Girardi P, Fernandes F, Favarato D, Lopes N, Borges JC, de Góis AFT, Ramires JAF. Quality of life after surgical myocardial revascularization, angioplasty or medical treatment. Arq Bras Cardiol 2008; 88:537-44. [PMID: 17589628 DOI: 10.1590/s0066-782x2007000500007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 01/26/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although the clinical benefits of coronary interventions seem to be confirmed, their effects on quality of life (QoL) are still scarcely studied. OBJECTIVE To assess the QoL in multivessel coronary disease in patients randomly undergoing surgery, angioplasty or medical treatment. METHODS The Short-Form Health Survey (SF-36) questionnaire was answered by 483 patients. Of these, 161 underwent surgical revascularization, 166 underwent angioplasty, and 153 were medically treated. RESULTS At baseline, 86% of the patients referred angina, 34% referred infarction, and 32% were smokers. Medical Treatment: 12 patients (7.7%) had AMI, 24 (15.3%) underwent surgery, and 19 (12.1%) died. In addition, 5 (3.2%) had stroke, and 40 (25.6%) had angina. As regards the mental component, 64.1% and 30.8% had their condition improved and worsened, respectively. As regards the physical component, 70.5% and 27.6% had their condition improved and worsened, respectively. SURGERY 13 patients (8.1%) had AMI, 2 (1.2%) underwent surgery, and 12(7.4%) died. Also, 9 (5.6%) had stroke and 30 (18.6%) had angina. As regards the mental component, 72.7 % and 25.5% had their condition improved and worsened, respectively. As regards the physical component, 82.6% and 16.1% had their condition improved and worsened, respectively. Angioplasty: 18 patients (10.9%) had AMI, 51 (30.7%) underwent interventions, and 18 (19.9%) died. Additionally, six (3.6%) presented stroke and 35 (21%) reported angina. As regards the mental component, 66.9% and 26.5% had their condition improved and worsened, respectively. As regards the physical component, 77.1% and 20.5% had their condition improved and worsened, respectively. CONCLUSION Improvement was observed in all domains and in the three therapeutic modalities. Comparatively, surgery had provided a better quality of life after a four-year follow-up.
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Takiuti ME, Carrara D, Hiscock SA, Favarato D, Lopes NH, Hueb WA, Oliveira SA, Ramires JA. 1115-67 The medicine, angioplasty, or surgery study (MASS II): Quality of life of patients with symptomatic multivessel coronary disease-24 months of follow-up. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91730-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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