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Adding Intervention Not Cost Effective in Coronary Disease

High hospitalization and medical costs observed in patients with established vascular disease

THURSDAY, Sept. 25 (HealthDay News) -- In patients with stable coronary artery disease, the addition of percutaneous coronary intervention (PCI) to optimal medical therapy is not a cost-effective initial management strategy, and treating patients with established vascular disease is associated with a substantial economic burden, according to two studies published in the September issue of Circulation: Cardiovascular Quality and Outcomes.

In one study, William S. Weintraub, M.D., of the Christiana Care Health System in Newark, Del., and colleagues from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluations (COURAGE) trial studied 2,287 patients who received either optimal medical care plus PCI or optimal medical care alone, and were followed for 4.6 years. For every life-year or quality-adjusted life-year gained with PCI, they found that the incremental cost-effectiveness ratio varied from a little more than $168,000 to a little less than $300,000.

"The economic outcomes in COURAGE are consistent with the clinical outcomes, which show that it is safe to defer PCI," Weintraub and colleagues conclude. "The present analysis suggests that such an initial management strategy will achieve appreciable savings in health expenditures."

In a second study, Elizabeth M. Mahoney, of Saint Luke's Hospital in Kansas City, Mo., and colleagues analyzed the cost of treating 23,974 patients with multiple atherothrombotic risk factors or a history of symptomatic disease. They found that the mean annual hospitalization cost ranged from $1,344 in patients with no affected arterial beds to $8,155 for those with three affected arterial beds. They also found that annualized medication costs ranged from $2,401 to $3,481. "These results reveal the high economic burden of atherothrombosis-related clinical events and procedures and the especially high economic burden associated with polyvascular disease," the authors write.

Both studies were supported by pharmaceutical companies. Several authors of both studies report financial relationships with the pharmaceutical industry.

Abstract - Weintraub
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Abstract - Mahoney
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