Health Affairs, 26, no. 1 (2007): 96 doi: 10.1377/hlthaff.26.1.96 © 2007 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Value & Price

PROLOGUE

Value And Price In Cardiovascular Disease Care

Two papers in this section use that approach to evaluate therapies related to cardiovascular disease, the leading cause of death in the country and also the largest cause of medical spending. David Cutler and his colleagues apply cost-benefit analysis to antihypertensive drugs, first estimating how much their increased use since 1959–62 has changed the distribution of blood pressure in the population, then using the Framingham equations to convert the result of much lower hypertension into fewer heart attacks and strokes, and finally assigning a monetary value to the increase in life expectancy the drugs have caused. Their analysis of one therapy affecting several different outcomes is complemented by Allison Rosen and colleagues, who look at several therapies—surgical as well as pharmaceutical—to prevent heart attacks or improve subsequent survival. They use the Framingham equations to convert risk-factor changes due to several different drugs into reduced adverse outcomes. Instead of putting a dollar value on the additional years of life gained, they estimate the incremental cost per life-year, separately for medical management and revascularization and separately for the general population and for those who have suffered an acute myocardial infarction. Both analyses conclude that the expenditure on medical therapy is a bargain offering a relatively low cost per year of life and a large social return on investment.

Both analyses also raise the question of why we haven’t done even better, since coverage of therapies is incomplete and many more lives could be saved. According to Kevin Hayes and colleagues, part of the reason is that we’ve got the relative prices wrong. Medicare prices appear to overpay for imaging and surgical interventions relative to medical management, making the less cost-effective therapies more profitable and encouraging rapid growth in their use. Besides costing more than necessary to control cardiovascular problems, this price distortion increases the risks of medical errors and iatrogenic disease. Both greater overall use of effective therapies and some substitution toward medical (drug) management are called for.

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