Implications of randomized studies of medical therapy vs revascularization for reducing rising costs of health care

Excerpt

While health care costs continue to rise, efforts to provide insurance coverage to more Americans will be accompanied by a multipronged approach to reducing these costs. To that end, considerable work is being done to determine the cost-effectiveness and appropriate use of expensive diagnostic imaging technology and costly therapeutic interventions. In the cardiovascular field, many experts are seeking to determine the most appropriate use of coronary revascularization strategies in patients with coronary artery disease (CAD). As medical therapy becomes more effective in managing risk factors for CAD and in eliminating or reducing symptomatic or silent ischemia, the benefit of revascularization as an initial strategy is reduced. Of concern to those working on ways to reform the health care system is the marked regional variation in the use of expensive technology, such as revascularization techniques that show no discernible differences in mortality. …