Minimal invasive extracorporeal circulation represents a dominant technique in coronary artery bypass grafting;insights from a cost-utility economic analysis

Abstract

Introduction

To evaluate the cost-utility of minimal invasive extracorporeal circulation (MiECC) versus conventional cardiopulmonary bypass (cCPB) in coronary artery bypass grafting (CABG) over a 7-years horizon.

Method

A cohort-based, deterministic cost-utility model was constructed from the Greek NHS perspective over a 7-year period. Clinical inputs were derived from a meta-analysis including 4849 patients. Direct medical costs for intensive care unit (ICU) and ward stay, blood transfusions, intra-aortic balloon pump (IABP) use, and perfusion circuits were applied to estimate the cost of care. Quality of life was quantified in terms of quality-adjusted life years (QALYs) by mapping SF-36 data to EQ-5D utilities. Deterministic sensitivity analyses were used to test key assumptions and a probabilistic sensitivity analysis assessed overall result robustness.

Results

MiECC was associated with improved clinical outcomes, including lower perioperative mortality and complication rates, shorter mechanical ventilation duration, and reduced lengths of ICU and ward stay. Over 7 years, patients operated on MiECC accrued 2.21 QALYs versus 2.18 QALYs for cCPB. MiECC dominated cCPB, yielding both cost savings (ΔCost = −1369€) and a QALY gain (ΔQALY = +0.03). Sensitivity analysis confirmed the robustness of the default results under all tested scenarios.

Conclusions

In an era focused on value-based care, cardiac centers and healthcare authorities should consider the integration of MiECC as a standard perfusion strategy in coronary surgery, given the supportive evidence of improved morbidity and mortality outcomes without financial impact concerns.