Cost estimates for treatment of cardiac ischemia (from the Asymptomatic Cardiac Ischemia Pilot [ACIP] study)

Costs for management of myocardial ischemia are enormous, yet comparison co st and outcome data for various ischemia treatment strategies from randomiz ed trials are lacking and will require cost and resource utilization data f ram a large prospective trial. The Asymptomatic Cardiac Ischemia Pilot prov ided feasibility data for planning such a trial and on opportunity to estim ate the long-term costs of different treatment strategies. Economic implica tions for ischemia management were compared in 558 patients with stable cor onary artery disease and myocardial ischemia during both stress testing and daily life. Participants were randomized to 3 different initial treatment strategies and followed for 2 years. Based on cost trends over follow-up, c osts for subsequent care were estimated. As expected, due to initial proced ural costs, at 3 months, estimated costs for revascularization were approxi mately 10 times greater than costs for a medical care strategy. Extrapolate d costs for anticipated resource consumption for care beyond 2 years, howev er, were approximately 2 times greater for an initial medical care strategy than for initial revascularization. This was due to increased need for dru gs and hospitalizations for bath late revascularizations and other ischemia -related events. Estimated costs for anticipated care in the medical strate gies reached the anticipated cost of the revascularization strategy within 10 years. Because this cost-equal time period is well within the median lif e expectancy for such a patient population, these findings could have impor tant public health implications and require testing in a full-scale prognos is trial. We anticipate that over the patients' life expectancy, early reva scularization is likely to become either cost-neutral or cost-effective. (C ) 1999 by Excerpta Medica, Inc.