Rapid developments in new health care technology in the cardiac field have become almost daily events. The technological development involves a wide range of applications of diagnostic modalities such as cardiac MRI, PET, CT angio or genetic screening for cardiac risk factors. It also covers countless therapeutic interventions, e.g., new anti-platelets, new pulmonary vasodilators, implantable cardioverter-defibrillators (ICD)drug-eluting stents, off pump coronary bypass, ventricular assist devices and robotic surgery. The term ‘‘technology creep’’ describes a phenomenon in which a certain technology first gets approved for a high-risk population in which there’s a proven benefit and its use then expands to lower-risk groups, changing the calculus of clinical and financial risk and reward. The ICD was first used for people who had survived cardiac arrest and are now ‘‘recommended’’ for primary prevention in patients with low ejection fraction (Epstein et al., 2008). The estimated cost per QALY for each device ranges between $50,300 and $70,200 (Health Technol Assess, 2006). Cardiac centers compete to attract doctors and patients by buying advanced tools. If Hospital A has a PET scanner and cardiac MRI and Hospital B does not have them, Hospital B loses in reputation and volume. This is regardless of the degree of need or priority of the presence of these technologies in certain community.
Unfortunately, adopting these new technologies can put a huge burden in the health systems costs. The annual medical cost of a CVD in USA is exceeding $403.1 billion (Patel and et al., 2005). This is true not only at the individual patient management but also at the nationwide level decisions to adopt such technology. Since available resources are limited, delivering health services involves making decisions. Decisions are required on what interventions should be offered, the way the health system is organized, and how the interventions should be provided in order to achieve an optimal health gain with available resources, while, at the same time, respecting people’s expectations.