doi: 10.1161/01.CIR.0000021408.40925.63
(Circulation. 2002;106:626.)
© 2002 American Heart Association, Inc.
Clinical Cardiology: New Frontiers |
Medical Economics and the Assessment of Value in Cardiovascular Medicine: Part II
From the Outcomes Research and Assessment Group (D.B.M.), Duke Clinical Research Institute, Durham, NC, and the Department of Health Research and Policy (M.A.H.), Stanford University, Stanford, Calif.
Correspondence to Daniel B. Mark, MD, MPH, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail daniel.mark@duke.edu
Key Words: cost-benefit analysis • cardiovascular diseases • financing
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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In Part I of this series, we reviewed some key concepts and tools of medical economics.1 In this concluding article, we use case studies of contemporary cardiovascular technologies to demonstrate the application of these principles. Three different types of therapies are considered: expensive one-time therapies (eg, coronary revascularization), the costs of which occur predominantly in the present and the benefits of which may stretch years into the future; prevention therapies, which must be applied to large populations for many years to prevent future complications; and maintenance therapies, which are applied to a chronic illness (such as heart failure) to improve longevity and functional status and to decrease complications.
Coronary Revascularization
Vigorous medical innovation over the past 30 years has transformed cardiovascular medicine from a largely noninvasive diagnostic discipline to one that employs a substantial armamentarium of procedures and devices, many of them invasive and expensive. Coronary revascularization is one of the most commonly performed procedures in the United States today, with 686 000 percutaneous coronary revascularizations (PCIs) and 366 000 coronary artery bypass graft surgeries (CABGs) performed in 1997.2 Because CABG typically costs >$30 000 per procedure, and PCI 
$12 000 per procedure (including hospital and physician costs), the total direct cost for coronary revascularization in the United States alone exceeds $20 billion per year.
With such huge expenditures on coronary revascularization, skeptics might well ask whether society is receiving a good value for all the money spent. There is no simple answer to this question because coronary revascularization is applied to
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