A study released by the New England Journal of Medicine found that stent-and-ang
ID: 1168514 • Letter: A
Question
A study released by the New England Journal of Medicine found that stent-and-angioplasty procedures are not as helpful as bypass surgery for heart patients with two or three blocked arteries. The study involved nearly 60,000 patients with serious heart disease and calls into question the effectiveness of angioplasty, saying it carries with it a higher risk of death in the long run and that those who underwent angioplasty were more likely to need another procedure within three years as opposed to those who had bypass surgery. The companies that make the stents used in angioplasties say the research does not include newer drug-coated stents that may produce better outcomes. Experts anticipate that the study will result in more bypass surgeries and fewer angioplasties being conducted, which in turn will increase the cost of care since bypass surgery costs significantly more than angioplasty. This study is not the first to find an advantage to bypass surgery, which has been seen as more effective over the long run because it creates a new pathway in the heart, as opposed to simply opening up a diseased artery that may be prone to future blockages as is done in angioplasty.
Source: John Hechinger, “The Growing Case for Heart Surgery,” The Wall Street Journal, Mary 26, 2005.
1. This article describes a classic cost effectiveness problem: one procedure is more expensive and appears to have better outcomes in the long run, whereas the alternative treatment is less expensive but appears to have worse outcomes in the long run. Describe how you would determine which procedure is optimal from (a) the patient’s perspective, (b) the hospital’s perspective, and (c) society’s perspective.
2. Which “variables” might tip the scale in favor of one procedure versus the other? (For example, is the quality of life the same after each procedure? Do older patients respond better to one or the other?)
Explanation / Answer
1. The patient would always want to get well and remain well for the ramaining of his life. He would rather be more interested in long term solution for Bypass surgery which may be costly at first but can avoid many other social costs and medical costs in the long run. For example if a stent requires replacement in three years, the health will start showing deterioration signs much time earlier. But a bypass may get the patient avoid thse costs involved in repeated treatments after every three year and costs of skipping social and profesional life while one is going for angioplasty. That means Bypass is a better option, which is in long term cost effective and has best outcome in the long run.
On the other hand the hospital would always want angeoplasty for the patiens as it would ensure almost certain periodical revenues. The patients with angioplasty would certainly visit the hospital for checkups and inspection of the stents if they are working well or do they require replacement.
From the society's perspective, the better health a man can get the better it is for the society. The society would always be better off in the long run with Bypass surgery dine.
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