Economic considerations in managing patients with chronic stable angina.

OBJECTIVE

To quantify the economic burden of chronic stable angina in the United States, characterize recent trends in the use of coronary revascularization, and compare the clinical outcomes and long-term costs of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and medical management in patients with stable angina.

SUMMARY

The direct and indirect costs of stable angina are measured in tens of billions of dollars in the United States, with hospitalization contributing a large amount to the costs. The use of coronary revascularization, particularly PCI and insertion of coronary stents, has increased dramatically in recent years. The long-term costs of PCI and CABG are similar and high. Revascularization is sometimes used without an adequate trial of medical management, despite higher costs and a lack of evidence of long-term clinical benefits from revascularization.

CONCLUSION

Chronic stable angina is a costly condition. Medical management should be used before considering costly revascularization, unless medical management is contraindicated.