Cost-effectiveness of revascularization interventions for patients with stable coronary artery diseases: A critical review of the evidence and methodologies

Abstract

Stable coronary artery disease (CAD) is a major global cause of morbidity and mortality, and while revascularization strategies such as coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are widely applied, their long-term cost-effectiveness remains debated. This review systematically examined six published cost-effectiveness analyses (CEAs) comparing CABG, PCI, and optimal medical therapy (OMT), with methodological quality assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 framework and Drummond’s checklist. Five studies consistently identified CABG as the most cost-effective option over 5–21 years, measured in quality-adjusted life years (QALYs), life years (LYs), or major adverse cardiac and cerebrovascular event (MACCE)-free survival, while one study favored PCI over OMT in specific cases. Reporting quality varied across studies. While perspectives and comparators were generally stated clearly, inconsistencies were noted in discounting practices, sensitivity analyses, and generalizability, yielding CHEERS compliance scores ranging from 59.1% to 82.6%. Overall, the evidence suggests CABG offers superior economic value compared with PCI and OMT in patients with multivessel disease, whereas PCI should be reserved for carefully selected subgroups. Variability in methodological rigor underscores the need for standardized approaches to health economic evaluations, including greater adherence to CHEERS and Drummond’s principles, and future studies should integrate real-world data and broader cost perspectives to enhance applicability across diverse healthcare systems. Ultimately, aligning robust economic evidence with clinical judgment is vital for improving patient outcomes and ensuring sustainable healthcare delivery.