THE NEW-ZEALAND PRIORITY CRITERIA PROJECT .2. CORONARY-ARTERY BYPASS GRAFT-SURGERY

Priority criteria developed during a national project were used to con duct an audit of all 662 patients on waiting lists for coronary artery bypass surgery in New Zealand during spring 1996. Based on the observ ed distribution of priority scores, the cost of providing surgery to a ll patients down to various levels of priority was estimated. Descript ions incorporating life expectancy and quality of life implications of surgery were developed of the kinds of patients who would or would no t receive surgery at each of several possible funding levels. Cardiolo gists and cardiac surgeons agreed that a threshold of 25 points was a reasonable clinical goal but to work with a threshold of 35, which can be sustained with current levels of funding. All agree that the gap b etween these clinically preferred and currently afforded thresholds is a subject for wider societal dialogue and decision. The ability to me asure the size of the gap between clinical desirability and financial sustainability provides a new transparency to the problem of healthcar e resource allocation.