Economic Evaluation of Endoscopic vs Open Vein Harvesting

Background: Endoscopic vein harvesting is an alternative to open vein harvesting during coronary artery bypass grafting. Although endoscopic vein harvesting includes significant clinical benefits, few long-term cost-effectiveness studies have been performed, limiting its use in the United Kingdom. In this study, we assessed the cost-effectiveness of endoscopic vein harvesting compared with open vein harvesting from the United Kingdom's National Health Service perspective. Methods: A Markov model was developed to estimate the cost-effectiveness of endoscopic vein harvesting vs open vein harvesting by investigating the incremental lifetime costs per quality-adjusted life-year gained. A scoping literature review was conducted to inform the development of the model. One-way and probabilistic sensitivity analyses examined the robustness of the results. Results: Compared with open vein harvesting, endoscopic vein harvesting leads to cost savings of £68.46 and quality-adjusted life-year gains of 0.206 per patient over a lifetime perspective. Thus, endoscopic vein harvesting is a dominant treatment option over open vein harvesting (net monetary benefit: £6248.46). In the scenario analysis, which accounted for a high-risk population with respect to leg wound infections, the net monetary benefit was £7341.47. The probabilistic sensitivity analysis showed that endoscopic vein harvesting has a 62.3% probability of being cost-effective at a threshold of £30,000 per quality-adjusted life-year, highlighting uncertainties resulting from follow-up event rates. Conclusions: Endoscopic vein harvesting is a cost-effective method of harvesting a saphenous vein graft. Further clinical data beyond 5 years of follow-up are required to confirm the long-term cost-effectiveness.