Cost-effectiveness of on-pump and off-pump bypass surgery.

We read with great interest the comprehensive review by Murphy et al. This review of the published literature critically examines the potential benefits of off-pump coronary artery bypass surgery (OPCAB) compared with conventional coronary artery bypass grafting (CABG). A number of important endpoints were examined, such as inflammatory and cellular responses. Their impact on organ dysfunctions was studied, namely myocardial, renal and neurological injuries. Clinical trials, carefully reviewed by Murphy et al. have collectively indicated lower morbidity in patients undergoing OPCAB, compared with CABG, with equivalent mid-term outcome. In addition, comparison of the costeffectiveness of the two surgical techniques suggests significantly increased direct costs in patients undergoing CABG, compared with OPCAB, with a comparable increase in quality-adjusted years of life. Our group has previously reported on 102 patients undergoing either CABG or OPCAB. In keeping with previous results, we found that OPCAB was associated with a total reduction in direct and, importantly, non-direct (nonpatient related) costs of 3.357E per patient, compared with CABG. As in previous studies, this difference was due to significantly fewer post-operative complications and shorter hospital stay. We feel that in the era of significant economic constraints, coupled with continuously escalating medical costs, analyses on cost-effectiveness ratios of various interventions become essential not only for medical practitioners, but also for governments and health-care policymakers.