Cost and cost-effectiveness of cardiac surgery in elderly patients

Sandro Gelsomino, Roberto Lorusso, Ugolino Livi, Gianluca Masullo, Fabiana Luc, Jos Maessen, Gian Franco Gensini

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: Cost-effectiveness of heart surgery for elderly patients is still poorly defined. We evaluated outcome, quality of life (QoL), cost, and cost-effectiveness of octogenarians undergoing cardiac surgery. Methods: One thousand six hundred forty octogenarians undergoing various cardiac surgical procedures were prospectively studied between January 1998 and January 2009 and compared with similar patients aged 70 to 79 years. Several questionnaires were used to assess QoL. Six hundred age- and sex- matched healthy octogenarians and three hundred forty patients older than 80 years with medically treated valvular or coronary artery disease were healthy and unoperated control groups, respectively. In-hospital costs were obtained from the hospital's financial accounting department and cost-effectiveness was estimated and expressed as cost/QoL-adjusted life year (QALY) and cost-effectiveness ratio. Results: Significant improvements occurred in elderly patients in Role Physical (P <.001), Bodily Pain (P <.001), General Health (P = .004), Social Functioning (P <.001), and Role Emotional (P <.001), whereas Physical Functioning, Vitality, and Mental Health did not change (difference not signficant). Total direct costs were $5293 higher in the octogenarian group. Cost-effectiveness was $1391/QALY for elderly surgical patients, $516/QALY for younger cardiac surgical patients (P <.001 vs elderly), $897/QALY for untreated control group, and $641/QALY for healthy control group (P <.001 vs elderly surgical patients). The cost-effectiveness ratio for octogenarians was $94,426. Conclusions: Our findings confirm that cardiac surgery in elderly patients remains controversial from a cost-effectiveness standpoint, making econometric analysis an important component for any future evaluation of novel cardiovascular therapies. Our findings need to be confirmed by additional multicenter studies.

Original languageEnglish
Pages (from-to)1062-1073
Number of pages12
JournalJournal of Thoracic and Cardiovascular Surgery
Volume142
Issue number5
DOIs
Publication statusPublished - Nov 2011

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Thoracic Surgery
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Quality of Life
Control Groups
Cardiac Surgical Procedures
Hospital Costs
Multicenter Studies
Coronary Artery Disease
Mental Health
Pain
Health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Gelsomino, S., Lorusso, R., Livi, U., Masullo, G., Luc, F., Maessen, J., & Gensini, G. F. (2011). Cost and cost-effectiveness of cardiac surgery in elderly patients. Journal of Thoracic and Cardiovascular Surgery, 142(5), 1062-1073. https://doi.org/10.1016/j.jtcvs.2011.02.013

Cost and cost-effectiveness of cardiac surgery in elderly patients. / Gelsomino, Sandro; Lorusso, Roberto; Livi, Ugolino; Masullo, Gianluca; Luc, Fabiana; Maessen, Jos; Gensini, Gian Franco.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 142, No. 5, 11.2011, p. 1062-1073.

Research output: Contribution to journalArticle

Gelsomino, S, Lorusso, R, Livi, U, Masullo, G, Luc, F, Maessen, J & Gensini, GF 2011, 'Cost and cost-effectiveness of cardiac surgery in elderly patients', Journal of Thoracic and Cardiovascular Surgery, vol. 142, no. 5, pp. 1062-1073. https://doi.org/10.1016/j.jtcvs.2011.02.013
Gelsomino, Sandro ; Lorusso, Roberto ; Livi, Ugolino ; Masullo, Gianluca ; Luc, Fabiana ; Maessen, Jos ; Gensini, Gian Franco. / Cost and cost-effectiveness of cardiac surgery in elderly patients. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 142, No. 5. pp. 1062-1073.
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