Angioplasty for stable angina: Time to cut down on the little (£1 billion) luxuries

All the available evidence shows that angioplasty for stable angina provides only a small and transient improvement in symptoms over and above good medical treatment and does not prevent heart attacks. If angioplasty procedures for stable angina was cheap and risk-free that would probably be OK. But angioplasty is costly (around £5,000), potentially lethal and up to 8% of patients who undergo angioplasty for stable angina suffer a significant amount of heart damage as a direct result of the procedure. 

There is near unanimous agreement that in a resource limited system like the NHS,  it doesn't make sense to invest a lot of money in something that is only a little bit better than the cheaper, safer alternative of rehabilitation and getting the drugs right. In order to judge whether a treatment is worth the NHS's money, health economists came up with a way to calculate cost-effectiveness. The idea was that people are basically fair-minded and would not think it fair if all the budget was spent making the lives of a very small number of patients perfect while the rest of us had to suffer because there was no money left for us. They decided that if the NHS has to spend more than £30,000 on a treatment in order to produce a perfect quality of life in a patient for a whole year (QALY) it was too much. The most recent cost-effectiveness analysis for angioplasty is a staggering £150,000 per QALY. If this was a new drug, the National Institute for Health & Clinical Excellence (NICE) would not pass it. The government targets for angioplasty were set more than eight years ago and did not involve a NICE appraisal. At that time the evidence in favour of angioplasty was even more unfavourable than today and if NICE had applied the rigorous rules it uses today, angioplasty would have withered on the vine. In the absence of a sensible debate, the last decade has seen an unprecedented expansion in funding for angioplasty and stents. This expansion has been at the expense of effective low cost-alternatives. 

In these times of economic gloom it is odd that the government has no plans to review its plans to spend an estimated £1 billion plus over the next decade on angioplasty for stable angina. If the Department of Health isn't interested perhaps the treasury should be because the majority of the £1 billion earmarked for angioplasty in stable angina will go on imports from American and European manufacturers.

While the rest of us have to tighten our belts through the recession ahead, surely it makes sense to make sure the government is spending taxpayers' money wisely.