Cost-Effectiveness of Computed Tomographic Angiography Before Reoperative Coronary Artery Bypass Grafting A Decision-Analytic Model

Abstract

BACKGROUND: The risks of repeat thoracotomy can be reduced if thoracic multidetector computed tomographic angiography (CTA) is used to guide preventive surgical strategies (PSS: peripheral cardiopulmonary bypass, circulatory arrest, and non-median sternotomy). We sought to define the cost-effectiveness of CTA using a Markov model. METHODS AND RESULTS: We studied outcomes and costs of CTA and non-CTA strategies in a modeled cohort of 10 000 patients undergoing redo coronary artery bypass grafting. Rates of PSS implementation were anticipated to follow identification of risk by CTA. Transitions, costs, and utilities were informed by our experience and the literature. Sensitivity analyses inclu..