Endoscopic vein harvesting not cost-effective for CABG compared to open vein harvesting: JAMA

USA: The secondary analysis of cost outcomes from the REGROUP clinical trial showed that the use of endoscopic vein harvesting (EVH) was not associated with a cost reduction for the index CABG (coronary artery bypass grafting) procedure or follow-up care compared to open vein harvesting (OVH). The article was published in the JAMA Network Open.

Every year more than 800,000 coronary-artery bypass grafting surgeries are performed worldwide. CABG is very commonly performed for treating patients with ischemic heart disease. Harvesting the saphenous vein, as a graft was traditionally performed using open vein harvesting (OVH), but endoscopic vein harvesting (EVH) has become the dominant approach recently. EVH for coronary artery bypass grafting (CABG) has been developed to reduce leg wound morbidity and improve patient satisfaction. Value-based purchasing creates pressure to examine whether newer technologies and care processes, including new surgical techniques, yield any economic advantage.

Todd H, Health Economics Resource Center, California, USA and colleagues conducted a secondary analysis of the REGROUP Trial to compare health care costs and utilization between participants randomized to receive endoscopic vein harvesting (EVH) or open vein harvesting (OVH) during a coronary artery bypass grafting (CABG) procedure.

Investigators enrolled 1150 participants for the secondary economic analysis, conducted alongside the 16-site Randomized Endo-Vein Graft Prospective (REGROUP) clinical trial. Adults scheduled for urgent or elective bypass involving a vein graft were eligible. Participants were randomized, with 574 participants receiving OVH and 576 receiving EVH. Investigators extracted cost and utilization data for analysis. Discharge costs for the index procedure, as well as follow-up costs, were analyzed, with results from different statistical models compared to test for robustness (ie, lack of variation across models)

Key findings from the analysis are,

• The unadjusted mean (SD) costs for the index CABG procedure were nearly the same for both EVH and OVH, including facility costs, insurance costs, and physician-related costs.

• Follow-up costs were not statistically different for EVH and OVH. Both the cost and utilization results were consistent, and the cost analyses were precise.

The authors concluded that clinical trial data found no evidence of EVH being associated with lower discharge costs when compared with OVH. Based on clinical or economic criteria, none of the approaches was found to be superior to the other. Thus, the choice to use EVH or OVH may be best guided by the surgeon and patient preferences.

Wagner TH, Hattler B, Stock EM, et al. Costs of Endoscopic vs Open Vein Harvesting for Coronary Artery Bypass Grafting: A Secondary Analysis of the REGROUP Trial. JAMA Netw Open. 2022;5(6):e2217686. doi:10.1001/jamanetworkopen.2022.17686