He noted that the current health-care reimbursement system encourages the use of procedures over drug treatment. He also said some patients have the mistaken belief that they won ™t need medications if they have a procedure to fix a blocked coronary artery. Patients with diabetes and heart disease need to be on effective drug treatments whether or not they have a procedure.

The researchers assessed the costs of the different approaches by counting up medical bills over the first four years of the study, including charges for hospitalizations, doctors ™ visits, drugs, tests and nursing home placements. The average cost of treatment for all patients in the study was $70,000 over four years.

Additional findings: bypass and diabetes treatments

The study also assessed the cost effectiveness of bypass surgery and two different approaches to treating diabetes.

Bypass surgery is much more costly than drug treatment, running $20,000 more over four years on average. But while surgery is much more expensive than drug treatment, for patients with severe heart symptoms it appears to be cost-effective ” since people with more severe coronary disease suitable for bypass surgery were significantly less likely to have a heart attack or stroke, or die than patients treated with drugs alone.

The two different approaches to diabetes that were studied ” drugs that improve the body ™s response to insulin versus drugs that increase the delivery of insulin ” had comparable costs over four years. BARI 2D had previously shown that medical effectiveness of these approaches to drug treatment was similar too.

For the two diabetes treatments, there was no difference in heart attack or death, and no difference in cost. It comes down to preference, said Hlatky. For example, patients who dislike injections might favor the insulin sensitization treatment, which relies on pills instead of shots.

The NIH plans to continue gathering and analyzing data from these patients in the coming years. There could be longer-term effects that aren ™t yet apparent, said Hlatky.

med.stanford/