title: Variation in cost-effectiveness in coronary revascularization: a new paradigm for evaluation?
abstract: OBJECTIVE
  Cost-effectiveness has become an increasingly important tool in assessing the value of healthcare. The principles of cost-effectiveness and the need to standardize the methodology are discussed. Documented variation could be used to adjust reimbursement.
  
  
  RESULTS
  The US healthcare system continues to be under financial pressure. Although national health expenditures have slowed, growth rates continue to outpace gross domestic product. Spending in the coming years is expected to grow 7% annually. Treatment of cardiac disease, and in particular ischemic heart disease, is a significant portion of healthcare spending. A strategy to improve clinical and financial outcomes for revascularization procedures is essential. Recently, the SYNTAX trial and ASCERT have addressed cost-effectiveness as an outcome measure in revascularization for coronary artery disease.
  
  
  CONCLUSIONS
  Cost-effectiveness is becoming an important part of healthcare provider performance and patient outcomes. Difficulties in obtaining cost, resource use, and quality of life data are not insurmountable as recently documented in randomized and observational trials. Reimbursement has already been linked to costs and resource use in current regulation. As the payment systems move toward disease management, cost-effectiveness will be the measure of choice. The prevalence of cardiac disease in the US population will mandate its use in adjusting payments to these providers.
authors.affiliation: Virginia Cardiac Surgery Quality Initiative, Value Based Healthcare Solutions, Virginia, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Rich
authors.forename: Fred
authors.initials: F
authors.lastname: Edwards
mesh_terms: D003324:Coronary Artery Disease / Q000191:economics* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D009204:Myocardial Revascularization / Q000191:economics*; D014481:United States