Cost effectiveness of risk reduction: the managed care perspective

Coronary artery disease (CAD) is responsible for nearly $140 billion in healthcare expenditures each year. A major opportunity for cost savings lies in reducing the overutilization of hospitalization for CAD patients. This goal may be accomplished through several strategies: more precise diagnosis of CAD, primary and secondary prevention, and early intervention. Underutilization of health services and treatment also contributes to higher overall medical costs. Even though drug therapy incurs costs, effective medications can produce substantial savings by reducing the need for additional medical care. For example, lipid-lowering agents are particularly cost effective when used as secondary prevention in patients with CAD; however, only 25% of patients receive such therapy. Likewise, not all patients who suffer acute myocardial infarction are treated with any of the agents proven to reduce the risk of subsequent adverse cardiovascular events. The elimination of variability in prescribing practices should help optimize the cost effectiveness of therapies aimed at reducing CAD risk.