doi: 10.1161/CIRCULATIONAHA.105.560466
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;113:380-387.)
© 2006 American Heart Association, Inc.
Health Services and Outcomes Research |
Proliferation of Cardiac Technology in Canada
A Challenge to the Sustainability of Medicare
From the Institute for Clinical Evaluative Sciences (D.A.A., A.N., T.A.S.); the University of Toronto Clinical Epidemiology and Health Care Research Program, Sunnybrook & Women’s College site (D.A.A.); the Divisions of Cardiology, Schulich Heart Centre (D.A.A.), Clinical Epidemiology Unit, Sunnybrook & Women’s College Health Sciences Centre; and the Department of Health Policy, Management and Evaluation, University of Toronto (D.A.A., T.A.S.), Toronto, Canada.
Correspondence to Dr David A. Alter, Institute for Clinical Evaluative Sciences, G106-2075, Bayview Ave, Toronto, Ontario M4N 3M5, Canada. E-mail david.alter{at}ices.on.ca
Received May 5, 2005; revision received October 19, 2005; accepted October 31, 2005.
Background— Critics remain skeptical about the long-term sustainability of Medicare in Canada because of the proliferation of health technology and escalating expenditures. The objective of this study was to examine the temporal trends in the utilization and costs of cardiovascular technologies for the evaluation and/or management of patients with ischemic heart disease in Canada.
Methods and Results— This repeated cross-sectional population-based study of Ontario residents examined the temporal trends in the utilization and costs associated with echocardiography, stress (imaging and nonimaging) testing, coronary angiography, percutaneous coronary intervention (PCI), and bypass surgery between 1992 and 2001. Annual costs increased by nearly 2-fold over the 10-year study period and cumulatively accounted for more than $2.8 billion (Canadian) in expenditures. The proliferation in use of cardiac testing/interventions over time outstripped both demographic shifts and changes in the prevalence of coronary artery disease. Annual increases were widespread for all procedures (P<0.001) and ranged from 2% per year for nonimaging stress tests to 12% per year for PCI, after adjustment for age and sex. Generally, utilization rates were higher among the elderly, males, and those of low socioeconomic status. With few exceptions, annual increases in the utilization rates of cardiac tests and procedures were disproportionately higher among the elderly and women, but they were similar across socioeconomic subgroups. Increases in utilization appeared to reflect referrals toward higher-risk populations.
Conclusions— Although definitive conclusions about the appropriateness of temporal patterns cannot be ascertained, the proliferation of cardiac testing challenges the sustainability of Medicare in Canada, especially given uncertainty as to whether the accompanying incremental rise in total expenditures translates into significant outcome benefits in the population.
CLINICAL PERSPECTIVE
Related Article:
- Rising Rates of Cardiac Procedures in the United States and Canada: Too Much of a Good Thing?
- John Z. Ayanian
Circulation 2006 113: 333-335.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  L. P. Badano, G. Nucifora, S. Stacul, P. Gianfagna, M. Pericoli, L. Del Mestre, S. Buiese, R. Compassi, G. Tonutti, L. Di Benedetto, et al. Improved workflow, sonographer productivity, and cost-effectiveness of echocardiographic service for inpatients by using miniaturized systems Eur J Echocardiogr, June 1, 2009; 10(4): 537 - 542. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. C. Floyd, J. Yarzebski, F. A. Spencer, D. Lessard, J. E. Dalen, J. S. Alpert, J. M. Gore, and R. J. Goldberg A 30-Year Perspective (1975-2005) Into the Changing Landscape of Patients Hospitalized With Initial Acute Myocardial Infarction: Worcester Heart Attack Study Circ Cardiovasc Qual Outcomes, March 1, 2009; 2(2): 88 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Gerber, C. S. Rihal, T. M. Sundt III, J. M. Killian, S. A. Weston, T. M. Therneau, and V. L. Roger Coronary Revascularization in the Community: A Population-Based Study, 1990 to 2004 J. Am. Coll. Cardiol., September 25, 2007; 50(13): 1223 - 1229. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. T. Yan, R. T. Yan, M. Tan, A. Fung, E. A. Cohen, D. H. Fitchett, A. Langer, S. G. Goodman, and for the Canadian Acute Coronary Syndromes 1 and 2 Management Patterns in Relation to Risk Stratification Among Patients With Non-ST Elevation Acute Coronary Syndromes Arch Intern Med, May 28, 2007; 167(10): 1009 - 1016. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Gibbons Leading the Elephant Out of the Corner: The Future of Health Care: Presidential Address at the American Heart Association 2006 Scientific Sessions Circulation, April 24, 2007; 115(16): 2221 - 2230. [Full Text] [PDF]
|
|
|
|
|
|
S. M. Singh, P. C. Austin, A. Chong, and D. A. Alter Coronary Angiography Following Acute Myocardial Infarction in Ontario, Canada Arch Intern Med, April 23, 2007; 167(8): 808 - 813. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz and F. A. Masoudi The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1886 - 1895. [Full Text] [PDF]
|
|
|
|
 |
|
 Use of Cardiac Tests and Procedures: U.S. and Canada Journal Watch Cardiology, March 16, 2006; 2006(316): 5 - 5. [Full Text]
|
|
|
|
|
|
J. Z. Ayanian Rising Rates of Cardiac Procedures in the United States and Canada: Too Much of a Good Thing? Circulation, January 24, 2006; 113(3): 333 - 335. [Full Text] [PDF]
|
|
|
|
|
|
F.L. Lucas, M. A. DeLorenzo, A. E. Siewers, and D. E. Wennberg Temporal Trends in the Utilization of Diagnostic Testing and Treatments for Cardiovascular Disease in the United States, 1993-2001 Circulation, January 24, 2006; 113(3): 374 - 379. [Abstract] [Full Text] [PDF]
|
|