SYNTAX Analysis Studies Cost Effectiveness of Taxus Express²

March 28, 2009—Boston Scientific Corporation (Natick, MA) announced that David J. Cohen, MD, presented results from an analysis of economic and quality-of-life outcomes based on 1-year data from its SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial. The analysis found that although the overall cost effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery varied according to patient characteristics, PCI was more cost effective than CABG in patients with low or moderate coronary lesion complexity. CABG was more cost effective than PCI in the most complex disease. Both PCI and CABG improved quality-of-life measures.

Previously published SYNTAX data showed no difference in safety and efficacy outcomes between PCI and CABG in patients with low or moderate lesion complexity. The current finding that PCI was more cost effective than CABG at 1 year in these same patient groups supports PCI as a rational alternative treatment option for these patients, the company stated.

SYNTAX is a randomized, controlled, clinical trial comparing PCI using the Taxus Express² paclitaxel-eluting coronary stent system to CABG in patients with left main disease and/or significant narrowing of all three coronary arteries. SYNTAX's goal was to explore whether it is safe and effective to treat some or all of these surgical patients with PCI using the Taxus Express² stent.

The cost-effectiveness analysis compared the relative benefits in overall quality of life to the relative United States health care costs for both PCI and CABG. In patients with low or moderate lesion complexity, PCI was favored, providing more quality-adjusted life years and lower net medical costs than CABG. For patients with the most complex disease—and in whom the increase in repeat revascularization for PCI versus CABG was greatest—CABG provided slightly more quality-adjusted life years with no significant difference in net medical costs at 1 year.

Both PCI and CABG demonstrated equivalent rates of substantial improvement in angina relief as compared to baseline at 1, 6, and 12 months (57.6% for PCI vs 58.3% for CABG at 12 months; P = statistically insignificant). The number of patients who reported being angina free was comparable for PCI and CABG at 1 month (64.4% vs 61.6%) and 6 months (68.5% vs 72%; P = statistically insignificant for both) but was higher in the CABG group at 12 months (71.6% vs 76.3%; P = .05).

In addition, the study showed that total medical costs were $5,693 lower for PCI than for CABG for the initial hospitalization ($27,560 for PCI vs $33,254 for CABG) (P < .001) and remained $3,590 lower for PCI than CABG through 12-month follow-up ($35,991 for PCI vs $39,581 for CABG)

(P ≤ .001). The narrowing in the cost difference between hospital discharge and 12-month follow-up was the result of the cost of repeat revascularization procedures and higher long-term costs of antiplatelet medication in the PCI group.

"This analysis demonstrates that the cost effectiveness of PCI versus CABG depends largely on patient characteristics, notably lesion complexity as defined by the SYNTAX Score," commented Dr. Cohen.Ên