Cost‐Effective treatment of coronary artery disease—the new imperative

Large lipid‐lowering clinical trials have demonstrated a significant reduction in cardiovascular events and the need for cardiovascular procedures. These clinical end point trials used relatively weak treatment modalities, and when the cost savings of the reduced number of events is balanced against the estimated cost of treatment, the average difference is approximately $ 1,500 per patient per year. Arterio‐graphic trials have used similar or more aggressive lipoprotein therapy over shorter periods of time. Estimates of cost savings from reduced clinical events balanced against the cost of treatment in these studies indicate a wide spectrum of estimated patient costs. These estimates range between a cost of $2,273 per patient per year to a cost savings of—$ 901 per patient per year. Extrapolation to the United States population with coronary artery disease (CAD) suggests that greater than one billion dollars per year could be saved if patients with CAD received similar treatment and responded in a similar manner. volves both excellence in medicine and attention to cost containment issues. The need to practice medicine in a cost‐effective manner creates a challenge and an opportunity to provide a better cardiovascular treatment service that reduces costs and at the same time provides patients with a treatment arm previously relegated to a second or third level of importance. Preventive cardiology has now achieved a status that makes it an essential part of a complete cardiovascular service. Disorders of lipoprotein metabolism is one component of preventive cardiology, and recent investigations have demonstrated that proper diagnosis and treatment directed at the specific underlying disorder can significantly reduce the number of cardiovascular events, as well as the rate of arteri‐ographically determined progression. This article will focus on the potential cost savings that may accrue if appropriate diagnosis and treatment is undertaken.