Latest news with #CABG
RNZ News
20-05-2025
- Health
- RNZ News
Fiji hospital promises Kiwis complex surgeries for 'a fraction' of the cost in New Zealand
Open-heart surgery at Pacific Specialist Healthcare Hospital in Nadi. Photo: Shalendra Prasad A private hospital in Fiji is promising "state of the art care" for medical tourists worldwide, and right now it has its eyes set on New Zealand. Pacific Specialist Healthcare (PSH) chief executive Parvish Kumar said that his hospital is now accepting referrals for Kiwi patients. Kumar told RNZ Pacific that they can offer complex heart, brain, and spine surgeries for "a fraction" of the cost of private care in New Zealand, and with no wait time. "We are clearing patients here in Fiji and in the region, and we do have the space and scope to do more. So I thought, let me just extend this also to my fellow New Zealanders," he said. "Maybe at the same time we could also give them about a week or two week holiday in Fiji." Kumar said that his hospital can offer coronary artery bypass grafting (CABG), a common heart surgery, for around NZ$21,000. According to that would cost between $50,000 and $75,000 in Aotearoa if done privately. PSH also offers spinal cord decompression surgery for around $14,000 to $18,000, and major brain tumour removal for between $21,000 and $28,000. Private spinal surgery in New Zealand ranges between $30,000 - $250,000, according to PolicyWise. PSH Hospitals is Fiji's largest state-of-the-art 130-bed specialty private hospital situated opposite the Nadi International Airport in Legalega. Photo: PSH The added bonus: a week of recovery spent relaxing in Suva. Although these types of surgeries are free under Aotearoa's public health system, more and more patients are facing wait times exceeding four months. According to the Ministry of Health, the number of patients waiting longer than four months for treatment ranged from over 27,000 and over 37,000 from March 2024 to February 2025. Kumar said that he wants to make Fiji the premier destination for medical tourism in the Pacific, in line with the Fijian government's goals to improving both tourism and health infrastructure. Photo: PSH Group The Fiji government allocated FJ$451.8 million "to deliver quality health care services to Fijians" in its 2024-2025 Budget. In 2022, approximately two percent of Fiji's tourists engaged in health and medical activities during their visit, according to Tourism Minister Viliame Gavoka. Gavoka said that he would like to see Fiji's health infrastructure develop in order to attract more medical tourists. "Fiji aims to emulate successful examples like India, which attracts many Fijians and Pacific Islanders annually for medical treatments." This comes at a time when Fiji's public health system struggles to meet demand, thanks to rapidly aging health infrastructure and a shortage of supplies. RNZ reported in 2024 that Fiji's mental health system needs to nearly double the number of beds available for mental health patients. Kumar told RNZ that the state of Fiji's healthcare system has nothing to do with his hospital. "We are independently and privately funded." He said that he receives no funding from the government, but is currently pushing for tax relief. "In any country, the private system can always spearhead or fast-track development compared to the public system, because the public systems normally have a lot of bureaucracy and red tape." Dr Sarah Fairley, Medical director, Kia Manawanui Trust Photo: Kia Manawanui Trust However, doctors in New Zealand are generally skeptical about medical tourism. Dr Sarah Fairley, cardiologist and medical director of the Kia Manawanui Trust, told RNZ that PSH's offers seem too good to be true. "I think this is probably the first time that I have seen, and certainly my colleagues have seen medical tourism related to cardiac surgery." "I think people should really embark on this with an abundance of caution." Dr Fairley said that she believes most doctors would steer away from recomending that their patients go overseas, especially when it comes to the heart. A direct flight from New Zealand to Suva can take anywhere between 3 to 5 hours. That is enough time in the air, Dr Fairley said, for significant health risks to present post-surgery. "if you've had cardiac surgery where you've had a surgeon that puts an incision in your chest, you have to have a cut in your breast bone or your sternum to get to the heart, and that's essentially a fracture" That would increase the risk of deep vein thrombosis, or a blood clot in a deep vein. "I think certainly even a three hour flight in my head would be not without risk from a DVT point of view." "What is the cost of emergency evacuation or repatriating you back to New Zealand, where that can be managed?" Kumar said that, at the end of the day, a New Zealand doctor has to sign off on a patient coming in order for his hospital to accept them. "After the surgery has been done, then we'll give them the clearance and then they can fly back." In response to Dr Fairley's comments, Kumar said that PSH uses a team trained in advanced countries. "What we did was to simply recruit the same heart surgeons that the advanced hospitals in India were utilising, and together with the surgeon, we also recruited the support team from operating theatre staffs to ICU and recovery staff." "Our cardiac department has had an excellent 100% success rate and we are very proud of this. "While the NZ health system does provide open heart procedures for free to its residents/citizens, patients who are not that critical many times end up waiting to get the procedure done." Ultimately, that failure of Aotearoa's public health system to meet demand is the reason why this conversation is necessary, Dr Fairley said. "This is a reflection of the fact that the current system is failing lots of our patients." "There may be people that are getting into this position where they're desperate, I think fundamentally, that's the opportunistic thing about health care overseas."
Medscape
06-05-2025
- Health
- Medscape
CABG Still Superior to Stents Despite FAME 3 Endpoint Swap
What happened with the 5-year FAME 3 results is not right. The reporting of this trial comparing stenting vs coronary artery bypass graft surgery (CABG) in patients with multivessel coronary artery disease (CAD) defies proper scientific principles. The FAME 3 Trial of Stents vs Surgery FAME 3 tested the best strategy to revascularize patients with multivessel CAD. Three previous trials comparing percutaneous coronary intervention (PCI) vs CABG (SYNTAX, FREEDOM, and BEST) had all found surgery to be superior. But both technologies had advanced, perhaps PCI more than CABG. PCI is now done via the radial artery, dramatically reducing bleeding complications. What's more, the use of fractional flow reserve (FFR) to assess stenosis severity should ensure that drug-eluting stents are placed only in hemodynamically significant lesions. FAME 3 was conducted because it was now possible that PCI could prove equal to CABG. It was designed and powered as a 1-year noninferiority trial with follow-up at 3 and 5 years, 'if funding allows.' Original 1-Year Results The 1-year results were clear. The primary endpoint of all-cause death, myocardial infarction (MI), stroke, and repeat revascularization occurred in 10.6% of patients in the PCI group and 6.9% of those in the CABG group. The 50% higher rate of events with stenting had an upper bound of 2.2, which was well over the prespecified noninferiority margin of 1.45. (HR = 1.5; 95% CI, 1.1-2.2). Three components of the composite endpoint — death, MI, and repeat revascularization — were numerically higher in the PCI arm. The authors concluded that contemporary FFR-guided PCI was not noninferior to CABG at 1 year. The title of the accompanying editorial was "CABG versus PCI — End of the Debate?" The writer answered his own question in the affirmative. The FAME 3 trial bolsters the role of CABG as the benchmark for patients with multivessel coronary disease. "Bolster" is the correct verb because FAME 3 clearly corroborated the three previous trials. 3-Year Results and an Endpoint Change Then something happened. The FAME 3 investigators used a different endpoint (death, MI, and stroke) in reporting the 3-year results. Repeat revascularization was dropped. The result of this change was that the 30% higher rate of events in the PCI arm did not reach statistical significance (12% vs 9.2%; HR = 1.3; 95% CI, 0.98-1.83; P =.07). But if they had stuck to their original primary endpoint, the 3-year result would have been similar to the 1-year result. In fact, the accrual of more events from year 1 to 3, particularly in the stent arm (18.6% vs 12.5% for surgery), led to more confidence in this endpoint, as evidenced by tighter confidence intervals (HR = 1.5; 95% CI, 1.2-2.00; P =.002). The change in endpoint prompted the authors to now conclude there was 'no difference' in major adverse events between FFR-guided PCI and CABG. 5-Year Results The authors continued with their new endpoint for the 5-year results. Now, 16% of patients in the PCI arm experienced either death, MI, or stroke vs 14.1% in the CABG arm. The higher rate of events in the PCI arm did not reach statistical significance (HR = 1.16; 95% CI, 0.89-1.52; P =.27). If they had used the original primary endpoint that includes repeat revascularization, CABG would have been superior (25% vs 18% for CABG; HR = 1.44; 95% CI, 1.15-1.81). More events meant even tighter confidence intervals. The rates of MI and repeat revascularization were also higher after PCI. The authors once again ignored the trial's original endpoint and concluded that there was no difference in the death/MI/stroke endpoint. They also noted that a landmark analysis looking at years 2-5 found no accrual of benefit in the surgery arm. The results were presented at the 2025 American College of Cardiology scientific sessions where the lead sentence of the press release noted that 'in contrast to previous studies patients with severe triple-vessel heart disease fared equally well whether they underwent CABG or PCI.' Headlines in news coverage implied that stents had closed the gap and were equivalent to surgery. Comments To conclude that the two therapies were similar required a different endpoint that omitted repeat revascularization. Had the authors kept the original endpoint, FAME 3 at 5 years would have drawn a similar conclusion to the 1-year results and the three previous trials: CABG is superior to PCI for patients with multivessel CAD. I will make three arguments why this endpoint change and revised conclusion were inappropriate: First, repeat revascularization is a relevant clinical outcome. The authors obviously believed so because they chose to include it in the composite primary endpoint for the 1-year outcome. What's more, two observational studies have associated repeat revascularization with higher mortality. This makes sense because the rate of MI in the PCI arm of FAME 3 at 5 years was 60% higher than for surgery, so many of these repeat procedures probably were done for acute coronary syndrome. Second, changing the endpoint is improper science. The authors may argue that the change was prespecified, but I see no clinical reason why the PCI-vs-CABG question requires different endpoints at different follow-up times. The third reason that use of fewer events in the revised endpoint is problematic relates to statistical rules. The authors list as their first limitation that FAME 3 was not powered for secondary endpoints. Indeed the confidence intervals for the revised endpoint were wide and included the chance that PCI was more than 50% worse. What's more, the secondary endpoint of death, MI, and stroke was not adjusted for multiple comparisons, further introducing uncertainty. Conclusion My take-home is that while PCI and CABG have improved over time, CABG remains the superior strategy in patients with multivessel disease. The findings for FAME 3 at 5 years are no different from the 1-year outcomes. The only change has been in how the authors presented the results.
