Cost and cost-effectiveness

Summary

The objective of this chapter is to highlight cost issues in interventional cardiovascular medicine. In developed countries, treatment decisions for patients with coronary artery disease are based on patients’needs and seldom on economic information. Indeed, there is evidence that a nationwide revascularisation policy prolongs life expectancy by over one year at a cost of about $40,000 per added year of life. Thus, the debate has shifted to a discussion about the best and most cost-effective revascularisation strategies. For patients with acute coronary syndrome, the availability of facilities rather than the actual costs determines the choice between thrombolysis and percutaneous coronary intervention (PCI). However, when PCI is feasible, the economic discussion moves to the type of procedure and the use of stents. The high cost of drug-eluting stents (DES) has led many health authorities to develop guidelines which include the economic aspects and the likely added value of using DES. These guidelines are supported by many economic evaluations of DES conducted either with clinical trials or from registries. In the latter case, the indication bias must be dealt with. It is worth noting that both researchers and policymakers had to deal with the lack of evidence of improved survival resulting...