Productivity in Heart Attack Treatments #3

Productivity in Heart Attack Treatments #3

The reasons for the increase in the productivity of heart attack treatments are varied and appear to come from new and improved treatments as well as from better use of existing treatments. Heidenreich and McClellan (2001) apportion 34% of the increase in life expectancy after a heart attack between 1975 and 1995 to the increased use of aspirin, a

drug that was invented in the 19th century, and a further 17% of the increase to clot-busting drugs.

They arrive at these numbers by combining the fact that randomized clinical trials have consistently found a benefit from these treatments with the fact that their usage became much more prevalent between 1975 and 1995.

Using Medicare claims data and innovative methods designed to control for the fact that the data were not created from randomized clinical trials, McClellan and Newhouse (1997) find that surgical procedures reduce the probability of a patient's death within two years by an average of 27%.This suggests that the increased use of surgical procedures contributed to the increased productivity as well.

Are the increases in the costs of heart attack treatments commensurate with the increased benefits? Answering this kind of question is difficult for many reasons, not least because it involves coming up with a way to place a dollar value on the additional year of life that the treatments provide. Though such measures of the value of life are uncertain and controversial, they generally imply that the value of one year of life is much higher

As medical spending in general has increased in the U.S., so has spending on heart attack treatments. From the claims data, Cutler and McClellan (2001) find that the average Medicare spending per heart attack patient increased by $9,600, from $12,100 in 1984 to $21,700 in 1998, when expressed in constant 1993 dollars. It is not coincidental that both costs and surgical treatments, which are expensive relative to non-invasive treatments, have increased

dramatically.

By further examining billing data from an unidentified major teaching hospital, Cutler, McClellan, Newhouse, and Remler (1998) show that the real prices of surgical and non-invasive procedures have both remained roughly constant, on average. This implies that the increase in the costs of heart attack treatments is attributable to the increased use of surgical treatments. than $9,600, which is the increase in the costs of heart attack treatments between 1984 and 1998 noted above. As a result, research that has studied this issue

(see Cutler and McClellan 2001 and Jones 2001) finds that treatments for heart attacks are, on average, more economically supportable today than they were 20 years ago.

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