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Health economics is gaining increasing importance in cardiovascular disease management. This is not surprising given the growing numbers of treatments, devices and diagnostic tools available each year in an everlasting quest to prevent the further occurrence of cardiovascular events. The question that arrives inevitably then is—which treatments are worth their value?1 Owing to the increasing use of intracardiac defibrillators, cardiac resynchronisation, percutaneous valve implantations; the impending wave of stem cell-based technologies from myocyte replacement to cardiac autotransplantation; and the ever increasing array of diagnostic techniques from four-dimensional echocardiography to computed tomography angiography, cardiac magnetic resonance imaging and implantable reveal devices, the money spent on cardiovascular disease continues to escalate and therefore clinicians need to appreciate and generate cost-effectiveness data with which to inform clinical choices.
A search of PubMed,2 using the terms cost effectiveness or health economics and combining these with any of the terms cardiac, heart, cardiovascular or coronary, generates 4964 hits which when limited to core clinical journals leaves 1385 hits, with one of the older papers published in 1974 in the Annals of Internal Medicine entitled “Inputs into coronary care during 30 years—a cost-effectiveness study”. This number is even more impressive when we consider that a similar search for pacemakers in clinical core journals in humans reaches only 1173 hits. These observations suggest that a new language of information is being presented to the cardiovascular community in clinical journals, containing information about decision-making to help best practice, given the constraints on resources.
Today, even clinical guidelines are affected by economic restrictions which govern what may and may not be prescribed or reimbursed.3 The superiority of evidence based on a clinical trial is also no longer sufficient to guarantee wide use of a new treatment, with bodies such as SIGN4 and NICE-UK5 now …