Published 12 May 2009, doi:10.1136/bmj.b1924
Cite this as: BMJ 2009;338:b1924

Letters

Deprivation and prognosis

Waste not, want not

The first 150 words of the full text of this article appear below.

Pagano and colleagues sensibly recommend rehabilitation as a means of maximising the benefits of expensive cardiac interventions, especially death rates after cardiac surgery in socially deprived areas,¹ and rehabilitation has long been recommended as a means of avoiding expensive cardiac interventions.² New money is unlikely to appear during a recession, but rehabilitation services could easily expand if resources were reallocated from avoidable cardiac interventions.

All studies of angioplasty versus continued medical treatment for stable angina show that at best angioplasty only temporarily improves quality of life. The small overall benefit is so costly (£100 000-200 000 per QALY) that it exceeds the cost effectiveness barrier of the National Institute for Health and Clinical Excellence (NICE) (£30 000 per QALY) by between threefold and sixfold.³

In 1997, at the beginning of the study period, European guidelines on stable angina recommended comprehensive rehabilitation as a way of avoiding revascularisation and reducing drug . . . [Full text of this article]

¹ National Refractory Angina Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L14 3LB

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