| Abstract |
BACKGROUND:
Critics remain skeptical about the long-term sustainability of Medicare
in Canada because of the proliferation of health technology and escalating
expenditures. The objective of this study was to examine the temporal
trends in the utilization and costs of cardiovascular technologies for
the evaluation and/or management of patients with ischemic heart disease
in Canada.
METHODS AND RESULTS: This repeated cross-sectional population-based study
of Ontario residents examined the temporal trends in the utilization and
costs associated with echocardiography, stress (imaging and nonimaging)
testing, coronary angiography, percutaneous coronary intervention (PCI),
and bypass surgery between 1992 and 2001. Annual costs increased by nearly
2-fold over the 10-year study period and cumulatively accounted for more
than $2.8 billion (Canadian) in expenditures. The proliferation in use
of cardiac testing/interventions over time outstripped both demographic
shifts and changes in the prevalence of coronary artery disease. Annual
increases were widespread for all procedures (P<0.001) and ranged from
2% per year for nonimaging stress tests to 12% per year for PCI, after
adjustment for age and sex. Generally, utilization rates were higher among
the elderly, males, and those of low socioeconomic status. With few exceptions,
annual increases in the utilization rates of cardiac tests and procedures
were disproportionately higher among the elderly and women, but they were
similar across socioeconomic subgroups. Increases in utilization appeared
to reflect referrals toward higher-risk populations.
CONCLUSIONS: Although definitive conclusions about the appropriateness
of temporal patterns cannot be ascertained, the proliferation of cardiac
testing challenges the sustainability of Medicare in Canada, especially
given uncertainty as to whether the accompanying incremental rise in total
expenditures translates into significant outcome benefits in the population.
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