Abstract
ABSTRACT Medical technological progress has been shown to be the main driver of health care costs. A key policy question is whether new treatment options are worth the additional costs. In this analysis we assess the causal effect of percutaneous transluminal coronary angioplasty (PTCA), a major new heart attack treatment, on mortality. We use a full sample of administrative hospital data from Germany for the years 2005 to 2007. To account for non-random treatment assignment of PTCA, instrumental variable approaches are implemented that aim to randomize patients into getting PTCA independent of heart attack severity. Instruments include differential distances to PTCA hospitals and regional PTCA rates. Our results suggest a 4.5 absolute percentage point mortality reduction for patients who have access to PTCA compared to patients receiving only conservative treatment. We relate mortality reduction to the additional costs for this treatment and conclude that PTCA treatment is cost-effective in lowering mortality for AMI patients at reasonable cost-effectiveness thresholds.
Highlights
Medical technological progress is widespread in health care and has been shown to be the main driver of health care costs (e.g. Cutler and McClellan 2001; Newhouse 1992; Okunade and Murthy 2002)
In a bivariate regression of percutaneous transluminal coronary angioplasty (PTCA) on mortality (model (1)) we find an 11.7 pp reduction in mortality for PTCA patients compared to patients with a conservative therapy
This paper investigates whether the use of new treatments (i.e. PTCA) for Acute myocardial infarction (AMI) leads to a reduction in mortality compared to conserva tive/old therapy
Summary
Medical technological progress is widespread in health care and has been shown to be the main driver of health care costs (e.g. Cutler and McClellan 2001; Newhouse 1992; Okunade and Murthy 2002). Cutler (2007) uses the same instrument and Medicare data as McClellan, McNeil, and Newhouse (1994) He has the advan tage of being able to follow patients for up to 17 years, but only those AMI patients admitted in 1986–1988. Sanwald and Schober (2017) exam ine the effect for patient’s treatment at a PTCA hospital with an Austrian dataset from 2002 to 2011 They find a 9.5 pp reduction in 3-year mortality for patients treated in a PTCA hospital. We extract this information from the variable discharge reason which can have the following main specifications: treatment ended regularly, discharge to nursing home or rehab hospital, or death.. This share is much lower in the group of patients who get a PTCA (4.0%) compared to patients who do not get a PTCA (11.4%)
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