Cost-effectiveness of accepted measures for intervention in coronary heart disease

Table 1 provides an overview of the cost-effectiveness of many of the coronary interventions discussed in this review. In order to compare the interventions, we updated the costs to 1992 US dollars using the medical care component of the Consumer Price Index. Although high-cost coronary interventions represent a substantial amount of the health care resources expended in the USA, the benefits afforded by these interventions in terms of increased life expectancy and health-related quality of life is substantial. In fact, because of the relatively high risk associated with patients with CHD, secondary coronary interventions are often more cost-effective than primary prevention strategies, the benefits of which are smaller and not realized for several years. Although cost-effectiveness analysis is an important methodology for determining whether the incremental cost of an intervention is reasonable in terms of its incremental benefit, limitations of this type of analysis exist. The quality of the cost-effectiveness analysis is directly affected by the quality of the data used. In addition, simplifying and extrapolating assumptions are unavoidable in these analyses. Therefore, each analysis should be carefully reviewed in order to fully interpret the reported cost-effectiveness ratios. In addition, in a rapidly changing held, the cost-effectiveness of a coronary intervention should be re-evaluated when new alternatives are introduced, when better efficacies are demonstrated, or when costs change. When faced with economic constraints, cost-effectiveness analysis provides a useful tool for the evaluation of coronary interventions. It is not sufficient to focus solely on effectiveness measures without taking into consideration costs and health-related quality- of-life. Alternatively, focusing only on the 'price tag' of a coronary intervention may lead to erroneous conclusions without taking into account the benefit to society afforded by the medical resources used. When feasible, cost-effectiveness analyses should play an integral part in the management of patients with coronary disease by clinicians and policy makers.