Abstract
Ischemic heart disease is a serious health problem because it causes considerable mortality and morbidity. Given the limited resources for health care, it is important to establish the costs associated with the benefits of its various treatment options. We therefore assessed the costs and benefits of medical treatment versus revascularization in a hypothetical cohort of 100 patients. A spreadsheet model was constructed using published data. The main outputs of this model were health-service costs per year and quality-adjusted survival estimates. In the United Kingdom, costs for treatments of less than £5000/quality-adjusted life-year (QALY) are perceived as highly cost effective, whereas those over £10,000/QALY are considered expensive. For patients with intractable symptoms, surgery is highly effective and has benefits on prognosis. In patients with well-controlled symptoms on medical therapy, the benefits of surgery are small and uncertain, and therefore medical therapy is the most cost-effective treatment. Overall, the preferred cost-effective option favored medical treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Goldman L, Gordon DJ, Rifkind BM, et al. Cost and health implications of cholesterol lowering. Circulation 1992;85: 1960–1968.
Weinstein MC, Stason WB. Cost-effectiveness of interventions to prevent or treat coronary heart disease. Ann Rev Public Health 1985;6:41–63.
Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: Overview of 10–year results from randomized trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994;344: 563–570.
Juul-Moller S, Edvardsson N, Jahnmatz B, Rosén A, Sørensen S, Ömblus R for the Swedish Angina Pectoris Aspirin Trial (SAPAT) Group. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. Lancet 1992;340:1421–1425.
Pedersen TR. Randomized trial of cholesterol lowering in 4,444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344:1383–1389.
Black AJR, Roubin GS, Sutor C, et al. Comparative cost of percutaneous transluminal coronary angioplasty and coronary artery bypass grafting in multivessel coronary artery disease. Am J Cardiol 1988;62:809–811.
Jang GC, Block PC, Cowley MJ, et al. Relative cost of coronary angioplasty and bypass surgery in a one-vessel disease model. Am J Cardiol 1984;53:52C–55C.
Kelly ME, Taylor GJ, Moses HW, et al. Comparative cost of myocardial revascularization: Percutaneous transluminal angioplasty and coronary artery bypass surgery. J Am Coll Cardiol 1985;5:16–20.
Reeder GS, Krishan I, Nobrega FT, et al. Is percutaneous coronary angioplasty less expensive than bypass surgery? N Engl J Med 1984;311:1157–1162.
Berreklouw E, Hoogsteen J, Van Wandelen R, et al. Bilateral mammary artery surgery or percutaneous transluminal coronary angioplasty for multivessel coronary artery disease? An analysis of effects and costs. Eur Heart J 1989;10: 61–70.
Hlatky MA, Lipscomb J, Nelson C, et al. Resource use and cost of initial coronary revascularization. Coronary angioplasty versus coronary bypass surgery. Circulation 1990; 82:IV208–IV213.
Hlatky MA, Charles ED, Nobrega F, et al. Initial functional and economic status of patients with multivessel coronary artery disease randomized in the Bypass Angioplasty Revascularization Investigation (BARI). Am J Cardiol 1995; 75:34C–41C.
Mark DB, Lai Choi LA, Lee KL, et al. Effects of coronary angioplasty, coronary bypass surgery, and medical therapy on employment in patients with coronary artery disease: A prospective comparison study. Ann Intern Med 1994;120: 111–117.
Sculpher MJ, Seed P, Henderson RA, et al. Health service costs of coronary angioplasty and coronary artery bypass surgery. The Randomized Intervention Treatment of Angina (RITA) trial. Lancet 1994;344:927–930.
Coronary Artery Surgery Study (CASS): A randomized trial of coronary artery bypass surgery. Quality-of-life in patients randomly assigned to treatment groups. Circulation 1983;68:951–960.
Williams A. Economics of coronary artery bypass grafting. Br Med J 1985;291:326–329.
The European Coronary Surgery Group. Long-term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet 1982;2:1173–1180.
Weinstein MC, Stason WB. Cost-effectiveness of coronary artery bypass surgery. Circulation 1982;66:III56–III66.
Dudley RA, Harrell FE, Smith LR, et al. Comparison of analytic models for estimating the effect of clinical factors on the cost of coronary artery bypass graft surgery. J Clin Epidemiol 1993;46:261–271.
Drummond M, Torrance G, Mason J. Cost effectiveness league tables: More harm than good? Soc Sci Med 1993;37: 33–40.
Cleland JGF, Bulpitt CJ, Falk RH, et al. Is aspirin safe for patients with heart failure? Br Heart J 1995;74:215–219.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cleland, J.G., Walker, A. Therapeutic Options and Cost Considerations in the Treatment of Ischemic Heart Disease. Cardiovasc Drugs Ther 12 (Suppl 3), 225–232 (1998). https://doi.org/10.1023/A:1007765723962
Issue Date:
DOI: https://doi.org/10.1023/A:1007765723962