Can Anyone Explain This?
At issue is how to treat about 500,000 Americans who each year develop “stable angina, ” which is chest pain that occurs in predictable fashion and is caused by blockages in the heart’s coronary arteries…
[I]n a $33.5 million clinical trial called COURAGE … 2,300 people with stable angina were given “optimal medical therapy” consisting of aspirin, beta blockers and statin drugs, along with help losing weight, quitting smoking and keeping blood pressure under control. Half were also randomly assigned to get angioplasty and stenting (PCI) … After nearly five years, the rate of heart attack and death in the two groups was essentially the same
A PCI procedure costs about $17,000. More than 500,000 are done each year in this country. Medicare pays for about 350,000 a year; this treatment alone accounts for at least 10 percent of Medicare’s total spending growth since the mid-1990s.
Source: Washington Post.
And what does a lifetime of drug therapy cost, even generics? The FAME and FAME 2 trials are finding who is appropriate for stents and who is not, saving the system money despite a couple hundred dollar device cost.
There is more money for the doctor in PCI.
This is another example of how both doctors and patients often prefer one-shot fixes (even if they don’t work) performed in discrete episodes rather than managing a condition piecemeal over time. Once your doctor performs a procedure, his job may be done. If, however, your doctor designs a regimen of ongoing care and you decide to move or fail to adhere to the regimen and die, he or she may see the care provided as a failure.
There is nothing inherently wrong with either approach. However, the problem is: people expect Medicare to pay for aggressive surgical interventions when lifestyle and disease management would probably be the preferred solution if seniors themselves were paying the bill.
responsible has a point. How would $17,000 compare to 10 or 20 years on prescription drugs?
Is is interesting that the outcomes are the same, it is possible that neither works.
Quality of life may be a consideration not addressed.
COURAGE didn’t address costs so no one knows how overall costs compare. It was only for people with chronic stable angina. These are fairly low risk patients, but even low risk patients can crossover to candidates for PCI.
Another unanswered question is what if the medical therapy isn’t “optimal” as is likely to be the case in community based care?
According to a Medscape summary article, there was some evidence that the rate of revascularization was higher (32.6 percent versus 21.1 percent) for people who had medical therapy. Also PCI was more effective in reducing ischemia for people with moderate to severe ischemia. Reducing ischemia in those folks did reduce death rates.
A problem that people have to grapple with is given that there is no difference in death rates, should one risk medical therapy given that one could suddenly become sicker and then have to undergo surgery when one is less able to withstand it?
It should be pointed out that those who underwent PCI still require medical therapy going forward to mitigate what ever pathology created the need for PCI. So the cost argument posed by Catherine may not hold up.
It may also be reasonable that a doc chooses the mechanical repair that can be definitely identified and proven to correct a condition versus the medical treatment that requires more time and risk that the patient may not respond accordingly.