Measuring Value From the Patient's Perspective

Abstract

With growing calls for scaling back medical spending in the United States, cardiac treatments in general, and revascularization procedures in particular, are receiving scrutiny. The American Heart Association estimates that in 2009, $93 billion in direct cost of care was attributed to ischemic heart disease in the United States.1 Much of this expense was due to an estimated 7 million cardiac procedures performed in the United States in 2006. These procedures include >1.3 million percutaneous coronary interventions (PCIs), and when coupled with a typical hospital charge of $45 000, it is clear that spending on PCI is a significant financial burden for the US healthcare system. Article see p 46 One of the drawbacks of PCI as a method of revascularization is the need for repeat procedures due to restenosis. This process is gradual and rarely life threatening, but often leads to symptoms of worsening angina, reduced quality of life, and significant expense for evaluation and treatment. The development of drug-eluting stents (DES) has been a major advance in the quest to reduce the restenosis rate, and they are now used in >70% of PCI procedures despite their higher initial cost of $1600 to $3200 compared with a bare-metal stent procedure.2 This rush to use a new technology, though not uncommon in United States, has led many to wonder whether this gain in quality of life is worth the added expense. A recently publicized case of overutilization of stenting has highlighted the skepticism that these procedures are appropriately used.3 To determine value of eliminating restenosis (eg, with DES), we have …