Modelling The Burden Of Cardiovascular Disease In Mexico And The Impact Of Reducing Modifiable Risk Factors

VA L U E I N H E A LT H

Taiwan, cost for hospitalization was $3,019 and $4,790 of annual cost per patient. In Thailand, cost for hospitalization was $5,285 and annual cost per patient was $7,181. In Malaysia, cost for hospitalization was $744 with $1,776 of annual cost. The length of stay per hospitalization was KR 12.2 days, TW 15.7 days, TH 14.2 days, and MY 5.5 days, respectively. Drug consumption varied in countries. Other than diuretics, the most frequently prescribed agent in 4 countries was nitrate in KR, anticoagulant in TW, and beta-blockers in both TH and MY.  Conclusions: The burden of HF is considerable and especially hospitalization is significant factor contributing to cost of disease. Consequently, effort to raise awareness of HF is required to reduce it. PCV59 Burden Of Cardiovascular Disease (CVD) For Patients With Familial Hypercholesterolemia (FH) Or Atherosclerotic Cardiovascular Disease (ASCVD) And The Impact Of Reducing Low Density LipoproteinCholesterol (LDL-C) Lowering In Latin American Countries Vianna D1, Habib M2, Villa G2, Qian Y2, Xiang P2, Bahia LR3, Alves FP4, Alva ME5, Ruiz Morales A6, Verdejo Paris J7 1Universidade do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil, 2Amgen, Thousand Oaks, CA, USA, 3Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, 4Amgen, São Paulo, Brazil, 5Amgen, Mexico City, Mexico, 6Pontifica Universidad Javeriana Medical School, Bogota, Colombia, 7Instituto Nacional de Cardiología, México DF, Mexico

Objectives: To estimate the burden of CVD and impact of LDL-C lowering in patients with FH or ASCVD with uncontrolled LDL-C levels in Mexico, Colombia, and Brazil.  Methods: The number of statin-treated patients with FH or ASCVD with uncontrolled LDL-C≥ 100mg/dL (≥ 2.6 mmol/L) in Mexico, Colombia, and Brazil was estimated based on country population and estimated disease prevalence. The clinical benefits of evolocumab as an add-on therapy to statins were derived from a long-term cardiovascular outcomes study (FOURIER) and the Cholesterol Treatment Trialists’ Collaboration, a large meta-analysis of statins outcomes trials, modeled over a lifetime to determine the impact on CV events, hospitalization costs, and quality adjusted life years (QALY).  Results: The number of statin-treated patients with FH or ASCVD with uncontrolled LDL-C was estimated at 0.15-0.37 million FH and 2.85 million ASCVD patients with uncontrolled LDL-C in Mexico; approximately 0.29-0.73 million FH and 2.5 million ASCVD patients in Brazil; approximately 0.06-0.15million FH and 0.50 million ASCVD patients in Colombia. Over the lifetime of an individual with FH, the additional LDL-C lowering with evolocumab is projected to result in a 0.52 (28%) CVD event reduction, and an increase in 3.26 QALY. The cost of hospitalization may decrease by $5,377USD in Mexico, $3,468USD in Colombia, $612 in Brazil. Similarly, over the lifetime of an individual with ASCVD, evolocumab was projected to result in a 0.44 (23%) CVD event reduction, and an increase in 1.84 QALY. For ASCVD patients, the cost of hospitalization may decrease by $4,603USD in Mexico, $2,883USD in Colombia, $512USD in Brazil.  Conclusions: CVD burden is significant in Latin America for FH and ASCVD patients. There are potentially long-term clinical, humanistic and economic benefits when LDL-C is reduced below target LDL-C goals. PCV60 Burden Of Illness Of Deep Vein Thrombosis In Europe – Mortality And Health Related Quality Of Life Monreal M1, Agnelli G2, Chuang L3, Cohen AT4, Gumbs PD5, Bauersachs R6, Mismetti P7, Gitt AK8, Kroep S3, Willich SN9, van Hout B10 1Hospital Universitari Germans Trias I Pujol, Barcelona, Spain, 2University of Perugia, Italy, Perugia, Italy, 3Pharmerit International, Rotterdam, The Netherlands, 4Guy’s and St Thomas’ NHS Foundation Trust, London, UK, 5Daiichi-Sankyo Europe GmbH, Munich, Germany, 6Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, Germany, 7Saint Etienne University Hospital, Saint Etienne, France, 8Herzzentrum Ludwigshafen, Ludwigshafen, Germany, 9Charité - Universitätsmedizin Berlin, Berlin, Germany, 10University of Sheffield, Sheffield, UK

Objectives: Deep-vein thrombosis (DVT) and pulmonary embolism (PE; collectively termed venous thromboembolism [VTE]) are a major healthcare burden in Europe, but exact estimates of this burden are lacking. This study reports results from the PREFER study concerning mortality and quality of life of DVT patients.  Methods: The PREFER in VTE registry was a prospective, observational, multicenter study, carried out in seven European countries, designed to provide data concerning treatment patterns, resource utilization, mortality and quality of life. Data was available for 2,056 patients with a first-time and/or recurrent DVT with follow up documentation at 1, 3, 6 and 12 months. Survival was analyzed using logistic regression, assessing the impact of baseline characteristics with a breakdown in cancer and noncancer patients. Quality of life - as measured by EQ-5D-5L – was analyzed using the similar variables applying a repeated measures tobit regression.  Results: In DVT patients with a mean age of 60 years, 42.9% with active cancer and 4.7% of those without active cancer died within a year. Higher age, the presence of liver disease and lower BMI were significant predictors in both groups. Additionally, smoking history, previous AF, major surgery, varicose veins or bed rest > 5 days were significant predictors in the non-cancer group. Average quality of life improved from baseline to 12 months in both the cancer (from 0.72 to 0.87) and non-cancer group (0.70 to 0.79). When scoring non-survivors at zero, average quality of life decreased in the cancer group to 0.55 at 12 months. Higher age, BMI and the presence of selected co-morbidities significantly added to the quality of life burden.  Conclusions: Mortality rates and quality of life estimates in DVT patients are below age-adjusted UK estimates. The effect of co-morbidities is significant and limits the potential to draw firm conclusions about the real “net” burden of DVT. PCV61 Burden Of Illness Of Pulmonary Embolism In Europe – Mortality And Health Related Quality Of Life Chuang L1, Gumbs PD2, van Hout B3, Agnelli G4, Cohen AT5, Bauersachs R6, Mismetti P7, Gitt AK8, Kroep S1, Monreal M9, Willich SN10, Jiménez D11 1Pharmerit International, Rotterdam, The Netherlands, 2Daiichi-Sankyo Europe GmbH, Munich, Germany, 3University of Sheffield, Sheffield, UK, 4University of Perugia, Italy, Perugia, Italy, 5Guy’s

20 (2017) A399–A811

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and St Thomas’ NHS Foundation Trust, London, UK, 6Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, Germany, 7Saint Etienne University Hospital, Saint Etienne, France, 8Herzzentrum Ludwigshafen, Ludwigshafen, Germany, 9Hospital Universitari Germans Trias I Pujol, Barcelona, Spain, 10Charité - Universitätsmedizin Berlin, Berlin, Germany, 11Hospital Universitario Ramón y Cajal, Madrid, Spain

Objectives: The incidence rate of pulmonary embolism (PE) is estimated at 0.95 per 1000 in Europe. The evidence of PE associated burden of illness in Europe is scarce. The aim of this study was to assess the burden of PE, in terms of mortality and health-related quality of life (HrQoL), as a function of patient characteristics, across Europe.  Methods: The PREFER in VTE registry was a prospective, observational, multicenter study conducted in seven European countries (France, Italy, Spain, UK, and DACH (Germany, Switzerland and Austria)). Venous thromboembolism (VTE) patients, following an acute event (index event), were recruited and followed at 1, 3, 6 and 12 months. The study sample was 1399 patients with PE. Subgroup analysis by country and with active cancer were conducted. The association between patient characteristics and mortality/HrQoL (EQ-5D-5L) were examined using a regression approach with the total sample.  Results: Average mortality rate at 12 months was 8.1%, varying between observed regions (1.4% in DACH to 16.8% in Italy), and substantially differed between patients with active cancer and those without (42.7% vs. 4.7%). Cancer was one of the most significant predictors for mortality, other predictors include age, BMI, more than 5 days bed rest, vascular disease, previous AF, smoking history and symptoms of palpitations. EQ-5D-5L index score at baseline (right after the index event) was 0.712 (SD: 0.265), and gradually improved to 0.835 (0.212) at 12 months. When scoring non-survivors at zero, average quality of life decreased to 0.743 at 12 months. Similarly, the index scores varied between observed countries and cancer subgroups. Active cancer, previous stroke and provoked VTE are amongst other significant factors for predicting index scores.  Conclusions: PE is associated with a substantial burden of illness – increasing mortality rate and decreasing HrQoL. Country variation exist and active cancer has a significantly large impact on PE burden. PCV62 Burden Of Illness Of Pulmonary Embolism In Europe – Healthcare Resource Utilization And Productivity Loss Willich SN1, Chuang L2, van Hout B3, Agnelli G4, Gumbs PD5, Bauersachs R6, Mismetti P7, Jiménez D8, Gitt AK9, Kroep S2, Monreal M10, Cohen AT11 1Charité - Universitätsmedizin Berlin, Berlin, Germany, 2Pharmerit International, Rotterdam, The Netherlands, 3University of Sheffield, Sheffield, UK, 4University of Perugia, Italy, Perugia, Italy, 5Daiichi-Sankyo Europe GmbH, Munich, Germany, 6Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, Germany, 7Saint Etienne University Hospital, Saint Etienne, France, 8Hospital Universitario Ramón y Cajal, Madrid, Spain, 9Herzzentrum Ludwigshafen, Ludwigshafen, Germany, 10Hospital Universitari Germans Trias I Pujol, Barcelona, Spain, 11Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Objectives: Pulmonary embolism (PE) is likely associated with a substantial economic burden to society, however, respective evidence in Europe is scarce. The aim of this study was to report healthcare resource utilization (HCRU) and absence from work of PE patients using the PREFER in VTE registry.  Methods: The PREFER in VTE registry was a prospective, observational, multicenter study in seven European countries, providing data concerning treatment patterns, HCRU, mortality and quality of life. Data was available for 1,399 patients with a first-time and/or recurrent PE with follow up documentation at 1, 3, 6 and 12 months. Descriptive statistics were presented by cancer and country subgroups. Logit and Cox regression was implemented to investigate the relationship between baseline characteristics and hospitalization and return to work, respectively.  Results: Average age was 62.3 years old. Cancer patients were mostly treated with heparin (84.9%), while noncancer patients were treated with combinations of heparin, VKA and NOACs. NOACs were used less in Italy and Spain (4.5% and 6.1 %). VTE-related re-hospitalization rate and average length of stay at 12 months varied substantially between countries, from 26.2% in UK to 12.3% in France, and from 12.9 days in Italy to 3.9 days in France, respectively. PE patients were often co-managed by general practitioners in France and DACH (Germany, Austria and Switzerland) (> 84%), whereas the number was lower in other countries (< 47%). The regression results confirmed the country variation of HCRU. Of working subjects, 60% returned to work at 1 month but more than 30% had not returned after one year. Cancer was a significant predictor for not returning to work.  Conclusions: Medical treatment of PE differs between cancer and non-cancer patients. VTE related resource utilization differs markedly between countries. Work-loss seems high in patients with PE, but may at least in part reflect the presence of co-morbidities. PCV63 Modelling The Burden Of Cardiovascular Disease In Mexico And The Impact Of Reducing Modifiable Risk Factors Gagnon-Arpin I1, Verdejo Paris J2, Sutherland G1, Dobrescu A1, Villa G3, Habib M4, Alva ME5, Suarez S5 1The Conference Board of Canada, Ottawa, ON, Canada, 2Instituto Nacional de Cardiología, México DF, Mexico, 3Amgen, Zug, Switzerland, 4Amgen, Inc., Thousand Oaks, CA, USA, 5Amgen, Mexico City, Mexico

Objectives: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Mexico, and quantify the impact of reducing modifiable risk factors.  Methods: A burden of disease model was used to forecast the burden of CVD in Mexico, and estimate the impact of reducing modifiable risk factors (tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity) in the general Mexican population, in accordance with World Health Organization (WHO) targets. Another model estimated the impact of reducing LDL-cholesterol through increased access to effective treatment for two high risk populations: heterozygous familial hypercholesterolemia (HeFH) and secondary prevention (SP), with a focus on patients with LDL-cholesterol > 100 mg/dL. Inputs for the models included disease and risk factor prevalence, population forecast, CVD event rates, and treatment effectiveness, primarily derived from the published literature. Direct costs to the

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public health care system and indirect costs from lost production due to premature mortality, hospitalizations, and absenteeism were included, although the cost of programs and pharmacological interventions to reduce risk factors was not considered.  Results: The prevalence of CVD is projected to increase to 2.7 million adults by 2035, while the economic burden, including both direct and indirect costs, would increase to US$24.9 billion. The value of reducing modifiable risk factors (except LDL-cholesterol) is estimated at US$28 billion over the forecast period. Similarly, the value of reducing LDL-cholesterol through increased access to effective treatment would be up to US$4.2 billion for HeFH patients and up to US$58.3 billion for SP patients over the forecast period.  Conclusions: The burden of CVD is significant and growing. Efforts to achieve WHO risk factor targets and further lower LDLcholesterol through increased access to effective treatment for high-risk patients are projected to greatly reduce the clinical, economic, and humanistic burden of cardiovascular disease in Mexico. PCV64 Burden Of Illness Of Deep-Vein Thrombosis In Europe – Healthcare Resource Utilization And Productivity Loss Chuang L1, van Hout B2, Cohen AT3, Gumbs PD4, Kroep S1, Monreal M5, Willich SN6, Agnelli G7 International, Rotterdam, The Netherlands, 2University of Sheffield, Sheffield, UK, 3Guy’s and St Thomas’ NHS Foundation Trust, London, UK, 4Daiichi-Sankyo Europe GmbH, Munich, Germany, 5Hospital Universitari Germans Trias I Pujol, Barcelona, Spain, 6Charité - Universitätsmedizin Berlin, Berlin, Germany, 7University of Perugia, Italy, Perugia, Italy

1Pharmerit

Objectives: Deep-vein thrombosis (DVT) forms a major healthcare burden in Europe, but exact estimates concerning the economic burden on society are lacking. This study reports results from the PREFER study concerning resource utilization and absence from work in DVT patients.  Methods: The PREFER in VTE registry was a prospective, observational, multicenter study carried out in Europe (France, Italy, Spain, the UK, and DACH [Germany, Switzerland and Austria]), designed to provide data concerning treatment patterns, resource utilization, mortality and quality of life. Data was available for 2,056 patients with a first-time and/or recurrent DVT, followed for 12 months. Data about resource utilization concerns only resource utilization directly related to DVT. Descriptive statistics were presented per country and by cancer subgroup. The probability of being hospitalized and length of stay were analyzed as a function of demographics, previous events and co-morbidities. Using similar variables, time until return to work was analyzed using Cox regression.  Results: Patients were on average 60 years old. Cancer patients were mostly treated with heparin (83.9%), non-cancer patients with heparin (63.1%), followed by VKA (45.0%). NOAC’s were less often used in Spain and Italy (< 7.0%). 20.5% of the patients with and 12.2% of patients without active cancer (n= 88 ; n=  1462) were hospitalized for on average 8.2 and 10.1 days, respectively. The hospitalization-rate was highest in Italy (16.7%) and lowest in France (7.7%). Furthermore, the average length of stay was highest in Italy (16.6 days) and lowest in DACH (5.2 days). Physician visits were highest in DACH (9.3), lowest in the UK (2.6). Of those working, 50% returned to work at 1 month; more than 30% never returned to work within 500 days.  Conclusions: Medical treatment of DVT differs between cancer and non-cancer patients. VTE-related resource utilization differs remarkably between countries. Work-loss seems high, but questions may be raised concerning the causality due to the presence of co-morbidities. PCV65 Short-Term Direct And Indirect Cost Burden of Cardiovascular Events In Patients With A History of Atherosclerotic Cardiovascular Disease In The US Johnson BH1, Bonafede MM2, Rane PB3, Patel J3, Harrison DJ3 Health Analytics, an IBM company, Cambridge, MA, USA, 2Truven Health Analytics, an IBM Company, Cambridge, MA, USA, 3Amgen Inc., Thousand Oaks, CA, USA 1Truven

Objectives: To estimate short-term direct and indirect costs of cardiovascular events (CVE) among patients with atherosclerotic cardiovascular disease (ASCVD)  Methods: The Truven Health MarketScan Commercial Database was used to identify adults (age ≥ 18-<64) with ASCVD and a CVE (index event) from 1/1/2014 to 9/30/2015. CVE was defined as an inpatient stay with admitting diagnosis of myocardial infarction (MI), ischemic stroke (IS), transient ischemic attack (TIA), unstable angina (UA), or inpatient or outpatient revascularization (coronary artery bypass graft or percutaneous coronary intervention) without an associated CVE. A 24-month pre-index period was used to assess ASCVD and patients were followed until death or 90 days, whichever occurred first. Short-term (90 day) direct healthcare costs were calculated for all patients. A subset analysis was conducted of patients in the MarketScan Health and Productivity Management (HPM) database to capture indirect costs due to productivity loss due to workplace absence (WA) and shortand long-term disability (STD and LTD). Direct and indirect costs were estimated across type of CVE.  Results: 8,870 patients met inclusion criteria (mean age 55.9, SD= 6.5; 32.7% female). The majority (42.0%) had revascularization as their index CVE, followed by MI (31.5%), IS (19.1%), TIA (5.8%), and UA (1.5%). Short-term direct costs following CVE were highest for revascularization patients ($74,179), followed by MI ($59,187), IS ($51,436) UA ($35,793) and TIA ($25,548). In the 90 days following CVE, patients accrued 19 WA, 16 STD and 5 LTD days with associated costs highest for IS ($7,857), followed by revascularization ($6,542), MI ($5,754) and TIA ($5,106); no eligible HPM patients had an index UA event.  Conclusions: The direct and indirect costs among ASCVD patients in the 90-days following a CVE are substantial ranging from $40,899 to $80,721. Reducing risk of CVE can potentially lower the direct costs and help employers decrease absenteeism and disability days for their employees. PCV66 Modelling The Burden Of Cardiovascular Disease In Turkey And The Impact Of Reducing Modifiable Risk Factors Malhan S1, Balbay Y2, Öksüz ME1, Gagnon-Arpin I3, Dobrescu A3, Sutherland G3, Villa G4, Habib M5, Ertugul G6

1Baskent

University, Ankara, Turkey, 2Ankara Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey, 3The Conference Board of Canada, Ottawa, ON, Canada, 4Amgen, Zug, Switzerland, 5Amgen, Inc., Thousand Oaks, CA, USA, 6Amgen, Isantbul, Turkey

Objectives: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Turkey, and quantify the impact of reducing modifiable risk factors.  Methods: A burden of disease model was used to forecast the burden of CVD in Turkey, and estimate the impact of reducing modifiable risk factors (tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity) in the general Turkish population, in accordance with World Health Organization (WHO) targets. Another model estimated the impact of reducing LDL-cholesterol through increased access to effective treatment for two high risk populations: heterozygous familial hypercholesterolemia (HeFH) and secondary prevention (SP), with a focus on patients with LDL-cholesterol > 100 mg/dL. Inputs for the models included disease and risk factor prevalence, population forecast, CVD event rates, and treatment effectiveness, primarily derived from published literature. Direct costs to the public health care system and indirect costs from lost productivity due to premature mortality, hospitalizations, and early retirement were included, although the cost of programs and pharmacological interventions to reduce risk factors was not considered. Results: The prevalence of CVD is projected to increase to 5.4 million adults by 2035, while the economic burden, including both direct and indirect costs, would increase to US$5.7 billion. The value of reducing modifiable risk factors (except LDL-cholesterol) is estimated at US$9.2 billion over the forecast period. Reducing the prevalence of uncontrolled LDL-cholesterol through increased access to evolocumab could lead to savings of up to US$691.3 million for HeFH patients and up to US$8.1 billion for high-risk SP patients over the forecast period.  Conclusions: The burden of CVD is significant and growing. Efforts to achieve WHO risk factor targets and further lower LDL-cholesterol through increased access to effective treatment for high-risk patients are projected to greatly reduce the clinical, economic, and humanistic burden of cardiovascular disease in Turkey. PCV67 Modelling The Burden Of Cardiovascular Disease In Brazil And The Impact Of Reducing Modifiable Risk Factors Gagnon-Arpin I1, Bahia LR2, Araujo DV2, Sutherland G1, Dobrescu A1, Villa G3, Habib M4, dos Santos RF5 1The Conference Board of Canada, Ottawa, ON, Canada, 2Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, 3Amgen, Zug, Switzerland, 4Amgen, Inc., Thousand Oaks, CA, USA, 5Amgen, São Paulo, Brazil

Objectives: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Brazil, and quantify the impact of reducing modifiable risk factors.  Methods: A burden of disease model was used to forecast the burden of CVD in Brazil, and estimate the impact of reducing modifiable risk factors (tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity) in the general Brazilian population, in accordance with World Health Organization targets. Another model estimated the impact of reducing LDL-cholesterol through increased access to effective treatment for two high risk populations: heterozygous familial hypercholesterolemia (HeFH) and secondary prevention (SP), with a focus on patients with LDL-cholesterol > 100 mg/dL. Inputs for the models included disease and risk factor prevalence, a population forecast, CVD event rates, and treatment effectiveness, primarily derived from the published literature. Direct costs to the public health care system and indirect costs from lost production due to premature mortality, hospitalizations, disability, and absenteeism were included, although the cost of programs and pharmacological interventions to reduce risk factors was not considered.  Results: The prevalence of CVD is projected to increase to 13.6 million adults by 2035, while the economic burden, including both direct and indirect costs, would increase to US$40 billion. The value of reducing modifiable risk factors (except LDL-cholesterol) is estimated at US$28 billion over the forecast period. Similarly, the value of reducing LDL-cholesterol through increased access to effective treatment would be up to US$4.6 billion for HeFH patients and up to US$39.2 billion for SP patients over the forecast period.  Conclusions: The burden of CVD is significant and growing. Efforts to achieve WHO risk factor targets and further lower LDL-cholesterol through increased access to treatment for high-risk patients are projected to greatly reduce the clinical, economic, and humanistic burden of cardiovascular disease in Brazil. PCV68 Myocardial Revascularization: Comparative Cost Study In South America Health Care System Tanaka GK1, Martins LV2, Greiffo RH3, Osternack B1, MatiaGd 4, Tanaka E5 1Pequeno Principe School Of Medicine, Curitiba , Paraná, Brazil, 2Faculdades Pequeno Principe, Curitiba , Paraná, Brazil, 3APOIO A SAUDE , CURITIBA, Curitiba, Brazil, 4Faculdades Pequeno Principe, Curitiba, Brazil, 5Curitiba’s Health Institute, Curitiba, Brazil

Objectives: To compare the procedure’ s costs for myocardial revascularization performed in 2004 and 2015,  and their variations among different cities hospitals accredited by Brazilian Government Health Care System ( BGHS), by the coronary bypass surgery (CBS) and percutaneous transluminal coronary angioplasty (PTA) among hospitals over a one-year follow up.  Methods: Data from 368 procedures and 86 patients were submitted to 87 CBS and 240 patients to 267 PTA, between January 2015 and December 2015, and October 2003 and April 2004 respectively, were collected. Each group was subdivided in, Subgroup A ( A1 to A5 ), B and C, in respect to the manner of payment.  Results: The mean cost for A subgroup were R$ 12.985,18 ( USD ~4.400 ), subgroup B ( CBS ) was R$ 7.759,78 ( USD ~2.900 ) per procedure; in the PTA group the cost/angioplasty was R$ 6.307.79 ( USD ~2.100 ). At the end of a year, the end values were R$ 7.875,73 ( USD~2.600 ) for the CBS and R$ 8.234,96 ( USD ~ 2.900 ) for the PTA group ( USD RATE 3:1 ).  Conclusions: The authors concludes that: There is a difference between subgroup A and B, regarding the median cost ( 33 % ), considering 10 years gap. The cost/angioplasty in the PTA group was minor than CBS group, and 50 % minor than CBS group ten years later.