A new study – a big one ($50 MM) – was recently released that compared the short and long term effects of drug eluding stents to bypass surgery for patients with serious heart disease. The headlines — “Heart Surgery Bests Stents” — pretty much told the story. In this particular case, 18% of those patients who had stents installed to treat their disease ended up either dying or needing another treatment over the next twelve months. Only 12% of bypass patients ended up with complications or passing on. The death rate in both instances was the same – 8%.
Stents — the tool of choice for interventional cardiologists — and bypass surgery — the technique of choice for cardiothoracic surgeons — have been playing this “which is better” game for almost ten years. Needless to say, both sides were represented in the stories that ran covering the results of this study. The bypass surgeons said, “More people should have bypass surgery instead of stents.” The stent docs said this study proved that stenting – which involves a much less aggressive and invasive procedure than bypass surgery — comes in a close second to bypass surgery, even in patients with complex conditions.
And if one chooses to read the comments underneath these articles at various online news sources, it’s pretty clear that both sides are doing the best they can to make their case, based on these results. To use a stupid sports analogy, it’s a lot like watching Federer and Nadal hit tennis balls at one another.
But what’s really interesting to me about all this is not one article – and not one comment – says anything about the cost of either procedure. For what it’s worth, stent procedures cost about a third of what bypass surgery costs – $20,000 vs. $60,000. These numbers can and do vary with every case – and may cost more or less based on the patient’s condition, where the service is delivered, and what part of the country you’re in. But around here, these procedures will average – for privately insured patients – somewhere around $20,000 and $60,000.
On some level, this is as it should be. Stents are often used for diagnoses that don’t require something as aggressive as bypass surgery, which is a far more invasive procedure. Stents generally serve a “less sick” population. But it still amazes me that when we talk about the relative performance of one service over another to treat illness in health care, we rarely talk about the cost of either one.
And just to complicate matters a little more, if you were to ask the CDC about why the per capita mortality rate for heart disease in this country has dropped by 50% over the past twenty years, they would say that improved surgical techniques could take about 5% of the credit. The lion’s share of the credit would go to advances in pharmacology (blood pressure meds and cholesterol lowering meds – like statins), and a huge drop in smoking.
This is why we need to make the collection and distribution of health care cost and quality data a national priority. We will never improve quality and reduce costs if we play this game one study at a time. Back when she was running for President, Democratic candidate Hillary Clinton talked a lot about creating a National Best Practices Institute for Health Care. I hope the folks that are left in that race pick up on this very fine idea and pursue it.