Article Summary

MIDCAB Procedure-An Economic Analysis

by The DiagnosisHeart.com Physician Team
Posted: May 20, 2003

Summary:
Investigators at the Department of Community Research and Community Education, The Hope Heart Institute, Seattle, Wash, USA have assessed the cost comparisons of minimally invasive direct coronary artery bypass through a thoracotomy (MIDCAB procedure) versus conventional coronary artery bypass grafting, off-pump bypass surgery through a sternotomy, or angioplasty with or without stenting.

The MIDCAB was compared to other procedures using a MEDLINE search from 1990 to 2002. The authors "critically appraised article adherence to a 10-item methodologic checklist modified to address issues particularly relevant to the MIDCAB procedure."

Ten articles published from June 1997 to March 2001 compared costs and (generally) outcomes of MIDCAB with those of other procedures. All were nonrandomized comparisons, generally of concurrent intrainstitutional clinical series. Stated results generally favored MIDCAB, angioplasty, or off-pump bypass surgery through a sternotomy relative to conventional coronary artery bypass grafting.

"Few studies adequately ensured the comparability of treatment groups, clearly performed intent-to-treat analyses, comprehensively and credibly measured costs that were considered, or clearly addressed costs and results of preprocedural angiography or postprocedural imaging," according to the authors.

The study has concluded that "most published comparative economic analyses of the MIDCAB procedure have failed to adequately address issues crucial to such evaluations. "

Editor's Comment: The MIDCAB procedure is a fairly new procedure, and any cost analysis attempts should measure the procedure against traditional coronary artery bypass surgery, which has been around for a long time. As such, comparisons are difficult and are subject to criticism. From a technical standpoint, the MIDCAB procedure has done well at mid-term follow-up (3-7 years).

Reference:
Comparative economic analyses of minimally invasive direct coronary artery bypass surgery, J Thorac Cardiovasc Surg

Date of Article Publication:
2003

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