The hard choices that we must make.

The cost of caring for patients with cardiovascular disease has increased more than 50% in the past five years. Much of this increase is due to the dissemination of new technologies that have proved effective for specific patient populations. Molecular biology, immunology, magnetic resonance imaging, and second generation cardiovascular drugs all promise more effective, noninvasive diagnostic and treatment methods--and continued higher costs. To avoid extreme solutions to cost-increase problems, results of clinical research must be better utilized to determine indications for high-cost procedures. Also important are improved methods of evaluating new technologies before dissemination; regionalization of high-cost services; and increased use of clinical data bases and sophisticated computer data handling, which furnish cost-effectiveness studies and tools for clinical decision-making.