Cost-effectiveness of multiarterial versus single-arterial grafting in coronary artery bypass surgery.

Objective: To evaluate the cost-effectiveness of multiarterial grafting (MAG) compared with single artery grafting (SAG) using institutional outcomes and a linked perioperative-chronic Markov model. Methods: This was a retrospective cohort study of 3583 adults undergoing isolated coronary artery bypass grafting between 2008 and 2022 at 2 tertiary hospital centers. Operative and perioperative data were obtained from the institutional Society of Thoracic Surgeons database. Propensity score overlap weighting was used to balance baseline covariates. A 2-phase (30-day perioperative and 10-year chronic) Markov state-transition model, informed by weighted institutional outcomes and supplemented with national Society of Thoracic Surgeons and Centers for Medicare & Medicaid Services data, was used to estimate long-term costs and quality-adjusted life years. Results: Among 3583 patients at 2 academic centers, MAG was associated with similar operative mortality and morbidity compared with SAG. In a linked perioperative-chronic Markov model, MAG yielded greater quality-adjusted survival (+0.241 quality-adjusted life-years) and lower 10-year discounted costs (-$7755 per patient). Sensitivity analyses demonstrated that MAG was not consistently cost-effective in the perioperative period but was robustly dominant in the chronic phase, with long-term results stable across a wide range of cost assumptions. Conclusions: MAG was associated with comparable perioperative outcomes but improved quality-adjusted survival and lower long-term costs compared with SAG. Broader adoption of MAG could reduce health care expenditures while improving population health by addressing barriers to MAG use, particularly in women, minority patients, and socially vulnerable populations.