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Conclusions In today's health care environment, decisions about medical interventions need to reflect measures of cost as well as clinical benefit. While it is clear that PTCA is significantly more expensive than medical therapy alone, analyses incorporating quality of life considerations suggest that angioplasty techniques that have been shown to improve clinical outcomes are, for the most part, cost-effective. For example, by reducing symptoms at a modest cost, balloon angioplasty appears to be reasonably cost-effective compared with medical treatment for patients with moderate to severe angina and single vessel coronary disease. Similarly, coronary stenting increases costs for most patients but is associated with improved outcomes compared with conventional PTCA. Formal cost-effectiveness analysis also suggests that these benefits are worth the cost; at least for patients with discrete stenoses that can be treated with a single stent. On the other hand, most other new devices-including rotational ablation, directional atherectomy, and excimer laser angioplasty-have not been shown to improve clinical outcome compared with balloon angioplasty. Given the higher procedural and hospital costs associated with these devices, it remains difficult to justify their use at present, except for specific lesion subsets for which angioplasty or stenting are unlikely to be successful or in the setting of ongoing clinical investigation.

Is a US analysis of cost-effectiveness in interventional cardiology relevant to a centrally funded health care system?