Opportunities to Improve Health Economic Outcomes in Coronary Artery Disease: A Review of Care Pathways in the United States Healthcare System

Abstract

Background: Despite medical advances, coronary artery disease remains the leading cause of death worldwide. Evidence suggests that current uptake and efficacy of strategies in coronary care are suboptimal. This review aimed to investigate key areas for improvements in coronary care in the United States, and to estimate the potential health gains if existing strategies were improved. Methods: A targeted literature review of the acute and chronic coronary artery disease care pathways was conducted to identify areas where health outcomes could be improved in the United States if uptake or efficacy of existing strategies were optimal. Using hypothetical scenarios of maximally improved efficacy or uptake from published literature and health impact modeling, we calculated potential additional lives saved and potential reductions in direct medical costs, using Medicare rates as proxy, if improvements were realized. Results: We identified the following areas where improvements in uptake or efficacy of existing strategies could positively impact coronary artery disease outcomes in the United States: primary prevention, early detection, efficient diagnosis, reducing time to reperfusion, and secondary prevention. Improvements in primary and secondary coronary artery disease prevention have the potential to reduce annual direct medical costs by approximately $17 billion USD and $5 billion USD, respectively. Further, if the efficacy of existing preventive strategies was improved to 80%, then 102,000 (primary prevention) and 32,000 (secondary prevention) lives could be saved annually. Improvements in early detection, more efficient diagnosis, and reducing time to reperfusion could also substantially increase lives saved by increasing the uptake and efficacy of timelier percutaneous interventions, and potentially reduce annual direct medical costs by $1 billion USD. Conclusions: Improvements in primary prevention offer the greatest potential for lives saved and medical costs avoided. Future innovations should focus on advancing existing primary preventive strategies, while simultaneously driving innovation towards developing effective novel strategies in each of the key areas for improvement.