International Journal of Technology Assessment in Health Care

General Essays

The Appropriateness of the Use of Cardiovascular Procedures: British Versus U.S. Perspectives

Steven J. Bernsteina1, Jacqueline Kosecoffa2, David Graya2, John R. Hamptona3 and Robert H. Brooka4

a1 University of California, Los Angeles

a2 Value Health Sciences, Inc., Santa Monica

a3 University Hospital, Nottingham

a4 RAND Corporation


To determine whether patients are less likely to receive an inappropriate procedure in countries that devote fewer resources to health care than does the United States, we studied how appropriately coronary angiography and coronary artery bypass surgery were performed in the Trent region of the United Kingdom. The medical records of 320 patients who underwent coronary angiography and 319 who underwent coronary artery bypass surgery in 1987 and 1988 were randomly selected for review. Despite the United Kingdom's more limited use of coronary angiography and coronary artery bypass surgery, a substantial proportion were still performed for less than appropriate reasons, by both U.S. and U.K. criteria. Merely reducing the rate of use of these procedures will not be sufficient to eliminate such inappropriate use.