Cost Effective Diagnosis and Treatment of Coronary Disease
J. David Talley, MD, Patrick D. Mauldin, PhD, Edmund R. Becker, PhD, eds. J. Willis Hurst, MD, series ed. Topics in Clinical Cardiology. 227 pp. Baltimore, Md: Williams & Wilkins; 1997. $69.00. ISBN 0-683-30302-3.
As the modern treatment of cardiovascular disorders becomes more and more expensive, greater emphasis will be placed on cost containment and outcome measures. We are clearly in the midst of a medical economic revolution as managed-care organizations make up an increasing portion of third-party payers. In addition, as the Medicare system confronts future bankruptcy as the baby boomers become senior citizens, cost containment will become an absolute necessity. So follows this timely book on the economics of treatment of cardiovascular disease, edited by a cardiologist (Dr J. David Talley) and 2 epidemiologists (Drs Patrick D. Mauldin and Edmund R. Becker).
The first section of the book summarizes current trends in the cost of managing coronary artery disease. In addition, the authors discuss changes occurring in the third-party-payer environment and update modifications in medical reimbursement. Also included is a brief review outlining the economic principles used in medical cost and outcome analysis, which provides the reader with a basis for the methods and data presented throughout the remainder of the book. The next section reviews strategies for diagnosing coronary artery disease, discussing both invasive and noninvasive strategies and which approach is most appropriate from both a clinical and economic standpoint. Also included is a chapter on appropriate and cost-effective perioperative risk stratification in patients with suspected or known coronary artery disease.
The third and fourth sections review all current data for treatment strategies and their application to acute and chronic coronary syndromes, including both medical therapy and invasive revascularization/treatment strategies. These chapters succinctly report the results of clinical trials pertaining to treatment of coronary artery disease, heart failure, and arrhythmias, addressing which therapies are most cost-effective and why. For example, the chapter on acute myocardial infarction outlines the latest clinical trial data for all medical and interventional therapies, explaining the relative clinical and economic merits of these treatments. The book ends with a section clarifying how the new medical economic environment will impact cardiovascular specialists. In addition, this last section stresses the importance of cost and outcomes analysis for assessment of interventional procedures and their operators. The book ends with a chapter by Dr Mauldin discussing why healthcare reform in the United States is so critical at this juncture.
This is a well-organized, all-encompassing, but concise review of data pertaining to effective strategies for the management of all aspects of coronary disease from unstable coronary syndromes to outpatient management of ischemic cardiomyopathy and heart failure. Not only did this compendium provide an update for evidence-based management of cardiovascular disease, but it also defines which diagnostic or therapeutic strategies are cost-effective. This book will be an excellent primary resource for the development of critical pathways for disease management. Its relatively short length (220 pp) makes reading this informative text from cover to cover possible and appropriate for cardiologists and primary care physicians alike. Drs Talley, Mauldin, and Becker should be commended for compiling such a compact but easy-to-read and informative text.
- Copyright © 1998 by American Heart Association