Economic analysis reveals shift toward high-cost percutaneous coronary intervention despite equivalent mortality in acute myocardial infarction, indicating financial incentives drive treatment choice.
Treatment of acute myocardial infarction (AMI) has been with tissue plasminogen activator (tPA) alone since 1987, at an original cost of $2,000 which has risen to $5,000. Over the past decade tPA has been replaced by percutaneous coronary intervention (PCI), an invasive, more time-consuming hospital procedure. The mortality results of the two treatments were similar, but the PCI cost and reimbursement are at least 5-fold higher. At the time, another fibrinolytic regimen was developed which is more effective, but it was ignored, and PCI continued to be the treatment choice and major source of revenue.
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Victor Gurewich (2020) studied this question.
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