Technological Development and Medical Productivity: Diffusion of Angioplasty in New York State, Issue 9311
National Bureau of Economic Research, 2002 - Medical innovations - 47 pages
A puzzling feature of many medical innovations is that they simultaneously appear to reduce unit costs and increase total costs. We consider this phenomenon by examining the diffusion of percutaneous transluminal coronary angioplasty (PTCA) -- a treatment for coronary artery disease -- over the past two decades. We find that growth in the use of PTCA led to higher total costs despite its lower unit cost. Over the two decades following PTCA's introduction, however, we find that the magnitude of this increase was reduced by between 10% and 20% due to the substitution of PTCA for CABG. In addition, the increased use of PTCA appears to be a productivity improvement. PTCAs that substitute for CABG cost less and have the same or better outcomes, while PTCAs that replace medical management appear to improve health by enough to justify the cost.
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additional PTCAs AMI patients analysis angina relief Angioplasty Revascularization Investigation benefit of angina benefit of PTCA Bypass Angioplasty Revascularization CABG and PTCA CABG or PTCA CABRI cardiac cholecystectomy clinical Column COPD Coronary Angioplasty coronary artery disease cost-to-charge ratios costs associated county of patient CSRS and CARS cumulative benefit Cutler disease Economic ejection fraction estimate figure fixed effects Hlatky hospital impact of PTCA improved in-hospital mortality includes increased incremental PTCA initial interaction terms left anterior descending levels logistic regression McClellan Medicaid medical productivity Medicare myocardial infarction NBER Working Paper patients receiving PTCA period PTCA and CABG PTCA for CABG PTCA patient PTCA Procedures PTCA rate PTCA relative PTCA's QALY quality-adjusted receiving CABG regression relative to CABG restenosis significant SPARCS data stents substitute for CABG substitution of PTCA surgery Table total costs Total Discharges treatment expansion patients Treatment Substitution variables Yea Yea York State Department