(Circulation. 1998;98:1040.)
© 1998 American Heart Association, Inc.
Cost Effective Diagnosis and Treatment of Coronary Disease
J. David Talley, MD, Patrick D. Mauldin, PhD, Edmund R. Becker, PhD,eds. J. Willis Hurst, MD, series ed. Topics in ClinicalCardiology. 227 pp. Baltimore, Md: Williams &Wilkins; 1997. $69.00. ISBN 0-683-30302-3.
Richard D. Patten, MD;
; Marvin A. Konstam, MD
New England Medical Center,
Tufts University School of Medicine,
Boston, Mass
As the modern treatment of cardiovascular
disorders becomes more and more expensive, greater emphasis will be
placed on cost containment and outcome measures. We are clearly in the
midst of a medical economic revolution as managed-care organizations
make up an increasing portion of third-party payers. In addition, as
the Medicare system confronts future bankruptcy as the baby boomers
become senior citizens, cost containment will become an absolute
necessity. So follows this timely book on the economics of treatment of
cardiovascular disease, edited by a cardiologist (Dr J.
David Talley) and 2 epidemiologists (Drs Patrick D. Mauldin and Edmund
R. Becker).
The first section of the book summarizes current trends in the cost of
managing coronary artery disease. In addition, the authors
discuss changes occurring in the third-party-payer environment and
update modifications in medical reimbursement. Also included is a brief
review outlining the economic principles used in medical cost and
outcome analysis, which provides the reader with a basis for
the methods and data presented throughout the remainder of the
book. The next section reviews strategies for diagnosing
coronary artery disease, discussing both invasive and
noninvasive strategies and which approach is most appropriate from both
a clinical and economic standpoint. Also included is a chapter on
appropriate and cost-effective perioperative risk
stratification in patients with suspected or known coronary
artery disease.
The third and fourth sections review all current data for treatment
strategies and their application to acute and chronic coronary
syndromes, including both medical therapy and invasive
revascularization/treatment strategies. These
chapters succinctly report the results of clinical trials pertaining to
treatment of coronary artery disease, heart failure, and
arrhythmias, addressing which therapies are most cost-effective
and why. For example, the chapter on acute myocardial infarction
outlines the latest clinical trial data for all medical and
interventional therapies, explaining the relative clinical and economic
merits of these treatments. The book ends with a section clarifying how
the new medical economic environment will impact
cardiovascular specialists. In addition, this last
section stresses the importance of cost and outcomes analysis
for assessment of interventional procedures and their operators. The
book ends with a chapter by Dr Mauldin discussing why healthcare reform
in the United States is so critical at this juncture.
This is a well-organized, all-encompassing, but concise review of data
pertaining to effective strategies for the management of all aspects of
coronary disease from unstable coronary syndromes to
outpatient management of ischemic
cardiomyopathy and heart failure. Not only did this
compendium provide an update for evidence-based management of
cardiovascular disease, but it also defines which
diagnostic or therapeutic strategies are cost-effective.
This book will be an excellent primary resource for the development of
critical pathways for disease management. Its relatively short length
(220 pp) makes reading this informative text from cover to cover
possible and appropriate for cardiologists and primary care physicians
alike. Drs Talley, Mauldin, and Becker should be commended for
compiling such a compact but easy-to-read and informative text.
