Cost-effectiveness of coronary interventions.

As the costs of medical care continue to rise, there has been increasing interest in evaluating the cost-effectiveness of medical practices. One area that has received particular scrutiny in recent years is percutaneous coronary revascularisation (PTCA). In the United States alone, more than 300 000 PTCAs are performed each year at an estimated cost of approximately US$3 billion. Despite the tremendous growth of the PTCA industry, however, there is still no evidence that the procedure improves survival compared with medical treatment, and only one small trial has examined the results of PTCA in a controlled fashion.' Given the cost of these procedures and the limited evidence of their overall effectiveness, it is understandable that PTCA is a prime target for cost containment efforts.