The Placement of Aortic Transcatheter Valve (PARTNER) trial: a health economic and policy perspective

Major advances in medicine have the curious property of simultaneously being the cause of both great excitement and great anxiety. Clinicians embrace the power of science to reduce human suffering and prolong life in ways that their forbearers could hardly have imagined. Patients, knowing little of the enormous theoretical and practical challenges to be surmounted in producing real medical breakthroughs, have been conditioned by the media to expect dramatic headlines in each morning's news reports as they sip their coffee. Healthcare payers and policy makers, reading those same reports, worry that consumers' enthusiasm for high-tech solutions to the chronic health problems of modern society is fueling a destructive growth rate in medical spending. Although cardiovascular medicine has no unique claim to technological innovation, the sheer number of patients affected with cardiovascular disease means that major technological advances addressing important clinical problems have measurable effects on the annual healthcare bill for the country. Over the last few decades, cardiovascular medicine has seen a series of remarkable, but expensive, therapeutic innovations evolve into guideline-endorsed standard care (eg, drug-eluting stents, implantable cardioverter-defibrillators, left ventricular assist devices). In each of these cases, the early dissemination phase of these technologies was marked by predictions that cardiovascular physicians, unable to restrain their enthusiasm for therapeutic novelty, would sink the national economy by adding billions of extra dollars to the already excessive annual healthcare bill. The apparent failure of such predictions to come true has left physicians increasingly inured to the voices of the Cassandras who make them. Administrative inefficiency and overuse of tests and therapies partially explain why the United States spends more than any other country on health care (17% of the gross domestic product at last accounting) but not why the spending continues to grow every year. Of the factors that account for the …