Stanford computer model shows bypass surgery more cost-effective than stents

vances so quickly, especially in cardiology," said Yock. "By the time they finished the follow-up to the BARI trial, one big objection was that it was already obsolete."

So Yock came up with a way to modernize the BARI trial with an elaborate computer model. Along with Mark Hlatky, MD, professor of health research and policy, they incorporated all the known information and expanded it to make estimates about what the costs and quality of life would be had a new technology, such as stents, existed then.

As the model's first test, it had to accurately replicate the results that were seen in the BARI trial. The researchers found that the model did indeed mimic the costs and quality-of-life measures seen in the trial. Once the model was shown to work, they could change parameters based on how much a new procedure costs, what complications it prevents and how it improves patient outcome. "The model allowed us to update the usefulness of the BARI trial for new technology and also to extend the data that we have for the trial, which was just 10 years long, through the lifetime of the patients."

Even the researchers were surprised by their findings. "We expected stenting to be much better than bypass surgery," said Yock. But, she explained, surgery also has had technological advancements, becoming safer and more effective, especially in older and sicker patients, without experiencing the same cost escalation as stenting.

Stents treat only the small section of the artery that has a blockage, while bypass surgery replaces a more extensive length of artery and therefore better protects against disease progression. "Stents are not the curative procedure that people think. If people choose stent procedures they should be prepared to come back," she said. "If your house has a major plumbing problem do you fix one drain, or replace the pipes?"

Surgery also provides better relief from chest pain. "People tend to think that less invasive is b

Contact: Mitzi Baker
Stanford University Medical Center

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