The cost of treating heart disease has become a key factor in decisions by US cardiologists grappling with the nation's No 1 killer. Record prices for drugs and devices, reduced reimbursement by insurance plans and the looming full implementation of the healthcare reform law are convincing doctors to consider not only novel treatments, but also how to get the most bang for the buck.
The trend was reflected at the annual scientific meeting of the American Heart Association, generally a forum for groundbreaking research on medications and devices to combat heart disease.
The conference for the first time last year featured an entire session on the economics of healthcare, including a study showing that eliminating drug co-payments for heart attack victims significantly reduced the chance that they would suffer another major cardiovascular problem.
The 2012 meeting, held last week in Los Angeles, included several dual presentations with companion studies on the economic impact of a drug or therapy as well as its safety and effectiveness. "We have an unsustainable economic model in healthcare delivery in the US," said Dr. Elliott Antman, professor of medicine at Harvard Medical School and chairman of the AHA Scientific Sessions Committee. "We all have to be conscious of ways we can be more cost efficient, and that includes understanding what the big breakthroughs mean in terms of cost."
Heart disease is the leading cause of death for both men and women in the United States, accounting for one of every four deaths, according to the Centers for Disease Control and Prevention.
It also is very expensive. AHA estimates that annual US medical costs of cardiovascular disease will reach $800 billion by 2030 - nearly triple the $272 billion spent in 2010.
"Rising costs of medical care make it very pertinent for us to assess value," said Dr. Mark Hlatky, director of the cardiovascular outcomes research center at Stanford University.
President Barack Obama's Affordable Care Act, which has now survived a challenge in the Supreme Court and a presidential election, is structured to reward quality of care, not the traditional fee-for-service model that can result in unnecessary treatment.
But the equation is not always simple.
One study presented at the AHA meeting showed that diabetics with diseased arteries not only fared better if they underwent bypass surgery rather than a less expensive stent procedure, but the surgery was also more cost effective. Researchers, funded by the National Institutes of Health, found that up-front costs for bypass surgery and hospitalisation were about $8,600 higher than costs for stent patients. But more stent patients either died or needed repeat artery clearing, while those who had surgery lived longer, higher-quality lives, resulting in lower, long-term healthcare spending for them.
Another study found that angioplasty to clear blocked arteries costs more at hospitals not equipped for emergency heart surgery, due mainly to follow-up costs. Elective angioplasty is becoming increasingly common at hospitals that do not conduct more complicated heart procedures.
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