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Ann Thorac Surg 2004;77:642-643
© 2004 The Society of Thoracic Surgeons

Invited commentary

Linda Shore-Lesserson, MD

Department of Anesthesiology Mount Sinai School of Medicine One Gustave L. Levy Place Box 1010 New York, NY 10029 USA

David L. Reich, MD

Department of Anesthesiology Mount Sinai School of Medicine One Gustave L. Levy Place Box 1010 New York, NY 10029 USA

David H. Adams, MD

Mount Sinai School of Medicine Department of Cardiothoracic Surgery Mount Sinai Medical Center 1190 Fifth Ave New York, NY 10029 USA

e-mail: linda.shore@mssm.edu
e-mail: david.reich@msnyuhealth.org
e-mail: david.adams@mountsinai.org

The first 20% of the full text of this article appears below.

Economic analyses that evaluate the short- and long-term implications of costly perioperative therapies are a sound method of determining the relative merits of these interventions. This study by Smith et al utilizes an elegant mathematical model of estimating the cost-effectiveness of aprotinin therapy in short- and long-term perspectives. This complex analysis may be summarized as follows:

1. FDA-sponored trials demonstrate superiority of full-dose aprotinin with respect to bleeding and stroke rate in reoperations.

2. Using cost-analyses derived from index data from Duke University Medical Center, a mathematical model was developed to estimate total perioperative costs (including the long-term costs of complications) of cardiac surgical procedures.

3. Application of this model led to the conclusion that aprotinin therapy reduced total cost in repeat cardiac operations, and was cost-neutral in primary operations.The authors have provided a comprehensive description of their methodology, as well as the limitations of their study. We . . . [Full Text of this Article]






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