Figure 2.
Effectiveness, cost differences, and incremental cost-effectiveness ratio (ICER) of CABG and DES-PCI. (A) Differences regarding major adverse cardiac and cerebrovascular events (MACCE). The x-axis describes the difference in effectiveness (Δe), with quadrants to the right of the y-axis representing the region where CABG is associated with a gain in effectiveness compared to PCI. The y-axis describes the cost difference (Δc), with quadrants above the x-axis representing the region where CABG is associated with an increase in costs compared to PCI. The slope of the line connecting the point (,) with the origin (0, 0) equals the estimated ICER. The slopes of the dashed lines represent the 95% confidence limits for the estimated ICERs. The dashed line represents the ICER and its 95% confidence interval of MACCE exhibits a trend towards cost-effectiveness favoring CABG (right upper quadrant). (B) Differences regarding AMI/death/stroke. The x- and y-axes and slope are similar to (A). The dashed line representing the ICER and its 95% confidence interval of AMI/Death exhibits cost-effectiveness favoring CABG, but the 95% confidence interval slips into the range favoring multivessel PCI (left upper quadrant). (C) Results of the bootstrap replications illustrate the distribution of the estimated ICERs in cost-effectiveness planes, where each point in the plane represents the estimated ICER of one bootstrap sample. The distributions of the estimated ICERs for the efficacy endpoint MACCE-free survival are predominantly in the “more effective, more expensive” quadrant of the figure (right upper quadrant). (D) The distribution of the estimated ICERs for the efficacy endpoint AMI/death/stroke-free survival shift to the “less effective” (left upper) quadrant, reflecting the unclear benefit of CABG as compared to PCI with respect to AMI/death/stroke-free survival. Percentages are the frequencies of samples in each quadrant. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]