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Does 'Aggressive Approach' Equal Higher Cost?

Stanley A. Forwand, MD
Arch Intern Med. 1995;155(3):335. doi:10.1001/archinte.1995.00430030133019.
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In their article, "Differences in the Treatment of Myocardial Infarction in the United States and Canada: A Comparison of Two University Hospitals,"1 the authors draw a common but unwarranted conclusion. They state that "the higher-cost, more aggressive approach to the care of the American patients was not associated with improved re-infarction and mortality rates either immediately or after long-term follow-up." The assumption that an aggressive approach results in higher cost is common, yet the cost of care was not measured in this study. The possibility exists that the "more aggressive approach" practiced at Stanford University (Palo Alto, Calif) reduced hospital days and thereby resulted in lower cost than a more conservative approach. Since the comparison crossed a national boundary, it is understandable that costs might have been difficult to compare. Differences in the value of the Canadian vs the American dollar would have to be considered, as would the


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