Therapeutic options and cost considerations in the treatment of ischemic heart disease.

Ischemic heart disease is a serious health problem because it causes considerable mortality and morbidity. Given the limited resources for health care, it is important to establish the costs associated with the benefits of its various treatment options. We therefore assessed the costs and benefits of medical treatment versus revascularization in a hypothetical cohort of 100 patients. A spreadsheet model was constructed using published data. The main outputs of this model were health-service costs per year and quality-adjusted survival estimates. In the United Kingdom, costs for treatments of less than 5,000 Pounds/quality-adjusted life-year (QALY) are perceived as highly cost effective, whereas those over 10,000 Pounds/QALY are considered expensive. For patients with intractable symptoms, surgery is highly effective and has benefits on prognosis. In patients with well-controlled symptoms on medical therapy, the benefits of surgery are small and uncertain, and therefore medical therapy is the most cost-effective treatment. Overall, the preferred cost-effective option favored medical treatment.