NCPA - National Center for Policy Analysis

Is Surgery Underused?

March 1, 2001

To reduce the cost of treatment, health care providers have turned increasingly to drug treatment as a less expensive alternative to surgery. However, some surgical costs have been reduced by using less invasive and therefore less risky surgical procedures that require less time for recuperation. And sometimes surgery is more effective than drug treatment.

For instance, balloon angioplasty is a procedure increasingly used to reopen clogged arteries, rather than more invasive surgery using grafts to bypass clogged arteries supplying the heart. However, a significant percentage of patients who would benefit from balloon angioplasty or bypass surgeries do not receive them, and suffer as a result, British researchers report in the New England Journal of Medicine.

  • Using an expert panel to evaluate patients, researchers found that 26 percent of 1,353 people in the study who should have received bypass surgery got drug treatment instead.
  • As a result, they were four times more likely than surgery patients to die or have a heart attack, and they were three times more likely to have chest pain years later.
  • 34 percent of those who should have received the balloon procedure to reopen their arteries did not receive that procedure.
  • As a result, the latter were twice as likely to have continuing chest pain.

An editorial in the same issue notes that data from well-insured populations in the U.S. show similar levels of underuse.

Source: Michelle Healy, "Study Finds Artery Surgery Underused," A Better Life, USA Today, March 1, 2001; Harry Hemingway et al., "Underuse of Coronary Revascularization Procedures in Patients Considered Appropriate Candidates for Revascularization," New England Journal of Medicine, March 1, 2001.


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