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- W2074057448 abstract "THOMAS S. RECTOR, PHD, GARY S. FRANCIS, MD, FACC Minneapolis, Minnesota The Survival and Ventricular Enlargement (SAVE) trial and other similar studies have clearly demonstrated that clinical benefits can be derived by prescribing angiotension- converting enzyme inhibitors for patients with substantial left ventricular dysfunction after a myocardial infarction. For example, risk reductions from 21% to 17% for death, 17% to 14% for hospital admission for heart failure and 15% to 12% for recurrent myocardial infarction were attrib- uted to captopril during an average follow-up period of 42 months in the SAVE trial (1). Undoubtedly, the cost of angiotensin-converting enzyme therapy is justified for those who experience these types of benefits. In a world with unlimited resources for health care, all treatments that have demonstrated efficacy would be utilized to as many people as possible. However, when resources of the payer are limited, someone must decide how to allocate resources to derive the greatest for a group of patients. Are physicians willing to change their long-standing approach to managing patients from being an advocate for each individ- ual patient regardless of cost to one of allocating resources among a group of patients? If not, government or health care administrators may become even more involved in clinical practice through incentives or restrictions designed to foster the use of the most cost-effective medical interven- tions. Given limited resources, use of medical interventions based on incremental cost effectiveness will provide more than any other method of allocating resources, assuming that benefits accruing to all patients in a health care system are valued equally (2,3). For example, a cost- effectiveness analysis might estimate that medications A and B provide 10 and 4 benefit and incur costs~f $5,000 and $500, respectively. If one had $25,000 to spend, one could get 50 units by treating 5 patients with medication A or 200 units by treating 50 patients with medication B. Note that even though medication A" @default.
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- W2074057448 date "1995-10-01" @default.
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- W2074057448 title "Cost-effectiveness analysis and clinical practice" @default.
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- W2074057448 doi "https://doi.org/10.1016/0735-1097(95)00347-0" @default.
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