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J Thorac Cardiovasc Surg 2008;135:809-815
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Is minimally invasive harvesting of the great saphenous vein for coronary artery bypass surgery a cost-effective technique?

Christopher Rao, MBBS, Omer Aziz, MRCS, Samer Deeba, MD, Andre Chow, MRCS, Catherine Jones, MBBS, Zhifang Ni, BSc, Leonidas Papastavrou, MD, Shamim Rahman, MBBS, Ara Darzi, FRCS, KBE, Thanos Athanasiou, PhD, FETCS*

Department of Biosurgery and Surgical Technology, Imperial College London, London, United Kingdom

Received for publication June 27, 2007; accepted for publication September 24, 2007.

* Address for reprints: Thanos Athanasiou, PhD, FETCS, Department of Biosurgery and Surgical Technology, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom. (Email: tathan5253{at}aol.com).

Objective: In this study we aim to assess the cost-effectiveness analysis of minimally invasive vein harvesting. The great saphenous vein is the most commonly used conduit in coronary artery bypass surgery. In the past decade minimally invasive techniques have been developed to reduce the surgical trauma associated with the conventional open vein-harvesting technique. There is strong evidence to suggest that minimally invasive harvesting can reduce postoperative wound healing complications, pain, mobility restriction, and hospital stay. Despite the increasingly widespread use of this technique, formal cost-effectiveness analysis has never been performed.

Methods: Economic analysis was performed according to the National Institute of Healthcare and Clinical Excellence guidelines on the evaluation of technology by using published data on postoperative pain and mobility restriction, locally collected data, National Health Service reference costs, and manufacturer's data. Probabilistic sensitivity analysis was performed to investigate and quantify the uncertainty associated with the results of our analysis.

Results: The results of our analysis demonstrate that minimally invasive vein harvesting was more cost-effective, with an incremental cost-effectiveness ratio of $19,858.87/quality-adjusted life year (QALY), comparing favorably with other health care interventions. Probabilistic sensitivity analysis demonstrated with 95.6% certainty that endoscopic harvesting was more cost-effective at a willingness-to-pay threshold of $50,000/quality-adjusted life year. Alternative analysis suggested that even with considerable uncertainty associated with quality of life after vein harvesting, minimally invasive harvesting was more cost-effective than conventional vein harvesting.

Conclusion: Minimally invasive harvesting is the most cost-effective method of harvesting the great saphenous vein and can significantly improve a patient's quality of life.

Abbreviations and Acronyms EQ-5D = EuroQol 5-dimension measure of health-related quality of life; HRQoL = health-related quality of life; ICER = incremental cost-effectiveness ratio; NHS = National Health Service; QALY = quality-adjusted life year; VAS = Visual Analog Scale






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