Health Economics

Dr. Daniel Mark’s most widely recognized contribution has been to develop the field of empirically based economic analysis and patient reported outcomes in large cardiovascular disease randomized trials. In the area of economic analysis, a pivotal early publication was the cost-effectiveness analysis of the GUSTO-I trial. This highly controversial trial pitted a genetically engineered molecule against an older “low tech” therapy for acute myocardial infarction. Dr. Mark obtained independent funding to collect detailed prospective economic and quality of life information on 3000 North American patients in this trial. The resulting work led to two first-author papers in the New England Journal of Medicine. In viewing this accomplishment, it is important to recognize that the work was done during a period when the major medical journals had grown quite cynical about cost-effectiveness analyses because of their perceived domination by industry concerns. Indeed, the New England Journal of Medicine had just published an editorial saying that they would no longer publish such analyses; but upon receiving Dr. Mark’s paper they decided not only to publish it but also to solicit an editorial about it.  This editorial stated that this study “sets a new standard for the integration of cost effectiveness into randomized trials.” Dr. Mark has gone on to conduct prospective economic analyses as part of the leadership team of over a dozen guideline-changing cardiovascular clinical trials.

Health Economics Studies

Health Economics Research Publications


Cost-Effectiveness of Left Atrial Appendage Occlusion: A Case Based on Facts Not in Evidence?

Pokorney SD, Mark DB.

Circ Arrhythm Electrophysiol. 2016 Jun;9(6). pii: e004223. doi: 10.1161/CIRCEP.116.004223. No abstract available. PMID: 27307520

Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease.

Mark DB, Federspiel JJ, Cowper PA, Anstrom KJ, Hoffmann U, Patel MR, Davidson-Ray L, Daniels MR, Cooper LS, Knight JD, Lee KL, Douglas PS; PROMISE Investigators..

Ann Intern Med. 2016 Jul 19;165(2):94-102. doi: 10.7326/M15-2639. PMID: 27214597

Economic analysis of ticagrelor therapy from a U.S. perspective: results from the PLATO study.

Cowper PA, Pan W, Anstrom KJ, Kaul P, Wallentin L, Davidson-Ray L, Nikolic E, Janzon M, Levin LÅ, Cannon CP, Harrington RA, Mark DB.

J Am Coll Cardiol. 2015 Feb 10;65(5):465-76. doi: 10.1016/j.jacc.2014.11.034. PMID: 25660925 Free Article

The economics of heart failure.

Kazi DS, Mark DB.

Heart Fail Clin. 2013 Jan;9(1):93-106. doi: 10.1016/j.hfc.2012.09.005. Review. No abstract available. PMID: 23168320

The Placement of Aortic Transcatheter Valve (PARTNER) trial: a health economic and policy perspective.

Mark DB, Mentz RJ.

Circulation. 2012 Jun 26;125(25):3243-5. doi: 10.1161/CIRCULATIONAHA.112.093120. Review. No abstract available.

PMID: 22733341 Free Article

Assessing the economic attractiveness of coronary artery revascularization in chronic kidney disease patients.

Eisenstein EL, Sun JL, Anstrom KJ, DeLong ER, Szczech LA, Mark DB.

J Med Syst. 2009 Aug;33(4):287-97. PMID: 19697695 Free PMC Article

Quality of life and economic outcomes with surgical ventricular reconstruction in ischemic heart failure: results from the Surgical Treatment for Ischemic Heart Failure trial.

Mark DB, Knight JD, Velazquez EJ, Howlett JG, Spertus JA, Djokovic LT, Harding TM, Rankin GR, Drew LA, Szygula-Jurkiewicz B, Adlbrecht C, Anstrom KJ; Surgical Treatment for Ischemic Heart Failure (STICH) Trial Investigators..

Am Heart J. 2009 May;157(5):837-44, 844.e1-3. doi: 10.1016/j.ahj.2009.03.008. PMID: 19376309 Free PMC Article

Long-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: results from the Treating to New Targets (TNT) Trial.

Mark DB, Knight JD, Cowper PA, Davidson-Ray L, Anstrom KJ.

Am Heart J. 2008 Oct;156(4):698-705. doi: 10.1016/j.ahj.2008.05.032. PMID: 18926150

Empirical estimation of life expectancy from large clinical trials: use of left-truncated, right-censored survival analysis methodology.

Nelson CL, Sun JL, Tsiatis AA, Mark DB.

Stat Med. 2008 Nov 20;27(26):5525-55. doi: 10.1002/sim.3355. PMID: 18613251

Long-term costs and resource use in elderly participants with congestive heart failure in the Cardiovascular Health Study.

Liao L, Anstrom KJ, Gottdiener JS, Pappas PA, Whellan DJ, Kitzman DW, Aurigemma GP, Mark DB, Schulman KA, Jollis JG.

Am Heart J. 2007 Feb;153(2):245-52. PMID: 17239685

The high cost of implantable defibrillators.

Hlatky MA, Mark DB.

Eur Heart J. 2007 Feb;28(4):388-91. Review. PMID: 17032689 Free Article

Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).

Mark DB, Nelson CL, Anstrom KJ, Al-Khatib SM, Tsiatis AA, Cowper PA, Clapp-Channing NE, Davidson-Ray L, Poole JE, Johnson G, Anderson J, Lee KL, Bardy GH; SCD-HeFT Investigators..

Circulation. 2006 Jul 11;114(2):135-42. PMID: 16818817 Free Article

What is the economic value of digoxin therapy in congestive heart failure patients? Results from the DIG trial.

Eisenstein EL, Yusuf S, Bindal V, Bourassa MG, Horney A, Collins JF, Mark DB; DIG investigators..

J Card Fail. 2006 Jun;12(5):336-42. PMID: 16762794

Costs for heart failure with normal vs reduced ejection fraction.

Liao L, Jollis JG, Anstrom KJ, Whellan DJ, Kitzman DW, Aurigemma GP, Mark DB, Schulman KA, Gottdiener JS.

Arch Intern Med. 2006 Jan 9;166(1):112-8. PMID: 16401819

Economic analysis of the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT-3) study: costs of reperfusion strategies in acute myocardial infarction.

Kaul P, Armstrong PW, Cowper PA, Eisenstein EL, Granger CB, Van de Werf F, Mark DB.

Am Heart J. 2005 Apr;149(4):637-44. PMID: 15990746

Surgeons’ economic profiles: can we get the “right” answers?

Eisenstein EL, Bethea CF, Muhlbaier LH, Davidian M, Peterson ED, Stafford JA, Mark DB.

J Med Syst. 2005 Apr;29(2):111-24. PMID: 15931798

Conducting economic evaluations alongside multinational clinical trials: toward a research consensus.

Reed SD, Anstrom KJ, Bakhai A, Briggs AH, Califf RM, Cohen DJ, Drummond MF, Glick HA, Gnanasakthy A, Hlatky MA, O’Brien BJ, Torti FM Jr, Tsiatis AA, Willan AR, Mark DB, Schulman KA.

Am Heart J. 2005 Mar;149(3):434-43. PMID: 15864231

Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II.

Al-Khatib SM, Anstrom KJ, Eisenstein EL, Peterson ED, Jollis JG, Mark DB, Li Y, O’Connor CM, Shaw LK, Califf RM.

Ann Intern Med. 2005 Apr 19;142(8):593-600. PMID: 15838065

Economic impact of new interventional therapies: are we asking the right questions?

Kong DF, Mark DB.

J Am Coll Cardiol. 2004 Nov 2;44(9):1809-11. No abstract available. PMID: 15519011 Free Article

Medical costs and quality of life 10 to 12 years after randomization to angioplasty or bypass surgery for multivessel coronary artery disease.

Hlatky MA, Boothroyd DB, Melsop KA, Brooks MM, Mark DB, Pitt B, Reeder GS, Rogers WJ, Ryan TJ, Whitlow PL, Wiens RD.

Circulation. 2004 Oct 5;110(14):1960-6. PMID: 15451795 Free Article

Economic impact of drug-eluting stents on hospital systems: a disease-state model.

Kong DF, Eisenstein EL, Sketch MH Jr, Zidar JP, Ryan TJ, Harrington RA, Newman MF, Smith PK, Mark DB, Califf RM.

Am Heart J. 2004 Mar;147(3):449-56. PMID: 14999193

34th Bethesda Conference: Task force #5–Is atherosclerosis imaging cost effective?

Mark DB, Shaw LJ, Lauer MS, O’Malley PG, Heidenreich P.

J Am Coll Cardiol. 2003 Jun 4;41(11):1906-17. Review. No abstract available. PMID: 12798557

Task force #2–the cost of prevention: can we afford it? Can we afford not to do it? 33rd Bethesda Conference.

Krumholz HM, Weintraub WS, Bradford WD, Heidenreich PA, Mark DB, Paltiel AD.

J Am Coll Cardiol. 2002 Aug 21;40(4):603-15. Review. No abstract available. PMID: 12204490 Free Article

Medical economics and the assessment of value in cardiovascular medicine: Part II.

Mark DB, Hlatky MA.

Circulation. 2002 Jul 30;106(5):626-30. Review. No abstract available. PMID: 12147547 Free Article

Medical economics and the assessment of value in cardiovascular medicine: Part I.

Mark DB, Hlatky MA.

Circulation. 2002 Jul 23;106(4):516-20. No abstract available. PMID: 12135955 Free Article

Vasopeptidase inhibitor reduces inhospital costs for patients with congestive heart failure: results from the IMPRESS trial. Inhibition of Metallo Protease by BMS-186716 in a Randomized Exercise and Symptoms Study in Subjects With Heart Failure.

Eisenstein EL, Nelson CL, Simon TA, Smitten AL, Lapuerta P, Mark DB.

Am Heart J. 2002 Jun;143(6):1112-7. PMID: 12075271

Obesity and long-term clinical and economic outcomes in coronary artery disease patients.

Eisenstein EL, Shaw LK, Nelson CL, Anstrom KJ, Hakim Z, Mark DB.

Obes Res. 2002 Feb;10(2):83-91. PMID: 11836453 Free Article

Variability in cost of coronary bypass surgery in New York State: potential for cost savings.

Cowper PA, DeLong ER, Peterson ED, Hannan EL, Ray KT, Racz M, Mark DB.

Am Heart J. 2002 Jan;143(1):130-9. PMID: 11773923

Assessing the clinical and economic burden of coronary artery disease: 1986-1998.

Eisenstein EL, Shaw LK, Anstrom KJ, Nelson CL, Hakim Z, Hasselblad V, Mark DB.

Med Care. 2001 Aug;39(8):824-35. PMID: 11468501

Evaluating the potential ‘economic attractiveness’ of new therapies in patients with non-ST elevation acute coronary syndrome.

Eisenstein EL, Peterson ED, Jollis JG, Tardiff BE, Califf RM, Knight JD, Mark DB.

Pharmacoeconomics. 2000 Mar;17(3):263-72. PMID: 10947301

Use of resources, quality of life, and clinical outcomes in patients with and without new Q waves after thrombolytic therapy for acute myocardial infarction (from the GUSTO-I trial).

Barbagelata A, Califf RM, Sgarbossa EB, Goodman SG, Knight D, Mark DB, Granger CB, Agranatti DA, Mautner B, Ohman EM, Suárez LD, Armstrong PW, Gates K, Wagner GS.

Am J Cardiol. 2000 Jul 1;86(1):24-9. PMID: 10867087

Economic end points in phase II trials.

Mark DB, Simons TA.

Am Heart J. 2000 Apr;139(4):S155-7. No abstract available. PMID: 10740122

Cost effectiveness of early discharge after uncomplicated acute myocardial infarction.

Newby LK, Eisenstein EL, Califf RM, Thompson TD, Nelson CL, Peterson ED, Armstrong PW, Van de Werf F, White HD, Topol EJ, Mark DB.

N Engl J Med. 2000 Mar 16;342(11):749-55. PMID: 10717009 Free Article

Cost-effectiveness of platelet glycoprotein IIb/IIIa inhibition with eptifibatide in patients with non-ST-elevation acute coronary syndromes.

Mark DB, Harrington RA, Lincoff AM, Califf RM, Nelson CL, Tsiatis AA, Buell H, Mahaffey KW, Davidson-Ray L, Topol EJ.

Circulation. 2000 Feb 1;101(4):366-71. PMID: 10653826 Free Article

Outcomes at 1 year and economic implications of platelet glycoprotein IIb/IIIa blockade in patients undergoing coronary stenting: results from a multicentre randomised trial. EPISTENT Investigators. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting.

Topol EJ, Mark DB, Lincoff AM, Cohen E, Burton J, Kleiman N, Talley D, Sapp S, Booth J, Cabot CF, Anderson KM, Califf RM.

Lancet. 1999 Dec 11;354(9195):2019-24. Erratum in: Lancet 2000 Mar 25;355(9209):1104. PMID: 10636365

Economic assessment of platelet glycoprotein IIb/IIIa receptor blockade with abciximab and low-dose heparin during percutaneous coronary revascularization: results from the EPILOG randomized trial. Evaluation in PTCA to Improve Long-term Outcome with abciximab GP IIb/IIIa blockade.

Lincoff AM, Mark DB, Tcheng JE, Califf RM, Bala MV, Anderson KM, Davidson-Ray L, Knight JD, Cabot CF, Topol EJ.

Circulation. 2000 Dec 12;102(24):2923-9. PMID: 11113041 Free Article

Cost estimates for treatment of cardiac ischemia (from the Asymptomatic Cardiac Ischemia Pilot [ACIP] study).

Pepine CJ, Mark DB, Bourassa MG, Chaitman BR, Davies RF, Knatterud GL, Forman S, Pratt CM, Sopko G, Conti CR.

Am J Cardiol. 1999 Dec 1;84(11):1311-6. PMID: 10614796

Clinical correlates of the initial and long-term cost of coronary bypass surgery and coronary angioplasty.

Hlatky MA, Boothroyd DB, Brooks MM, Winston C, Rosen A, Rogers WJ, Reeder GS, Smith HC, Ryan TJ, Pitt B, Whitlow PL, Wiens RD, Mark DB.

Am Heart J. 1999 Aug;138(2 Pt 1):376-83. PMID: 10426855

Acute and long-term cost implications of coronary stenting.

Peterson ED, Cowper PA, DeLong ER, Zidar JP, Stack RS, Mark DB.

J Am Coll Cardiol. 1999 May;33(6):1610-8. PMID: 10334432 Free Article

Economics and cost-effectiveness in evaluating the value of cardiovascular therapies. Use of abciximab: comparative economic data.

Mark DB, Simons TA.

Am Heart J. 1999 May;137(5):S123-5. No abstract available. PMID: 10220613

Economic and cost-effectiveness in evaluating the value of cardiovascular therapies. The impact of the cost-effectiveness study of GUSTO-1 on decision making with regard to fibrinolytic therapy.

Califf RM, Stump D, Topol EJ, Mark DB.

Am Heart J. 1999 May;137(5):S90-3. No abstract available. PMID: 10220606

Economics and cost-effectiveness in evaluating the value of cardiovascular therapies. Fundamentals of economic analysis.

Mark DB, Simons TA.

Am Heart J. 1999 May;137(5):S38-40. No abstract available. PMID: 10220594

Effects of stroke on medical resource use and costs in acute myocardial infarction. GUSTO I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries Study.

Tung CY, Granger CB, Sloan MA, Topol EJ, Knight JD, Weaver WD, Mahaffey KW, White H, Clapp-Channing N, Simoons ML, Gore JM, Califf RM, Mark DB.

Circulation. 1999 Jan 26;99(3):370-6. PMID: 9918523 Free Article

Value of exercise treadmill testing in women.

Alexander KP, Shaw LJ, Shaw LK, Delong ER, Mark DB, Peterson ED.

J Am Coll Cardiol. 1998 Nov 15;32(6):1657-64. Erratum in: J Am Coll Cardiol 1999 Jan;33(1):289. PMID: 9822093 Free Article

Outcomes and costs within a disease management program for advanced congestive heart failure.

Schulman KA, Mark DB, Califf RM.

Am Heart J. 1998 Jun;135(6 Pt 2 Su):S285-92. Review. No abstract available. PMID: 9630091

Economic assessment of low-molecular-weight heparin (enoxaparin) versus unfractionated heparin in acute coronary syndrome patients: results from the ESSENCE randomized trial. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q wave Coronary Events [unstable angina or non-Q-wave myocardial infarction].

Mark DB, Cowper PA, Berkowitz SD, Davidson-Ray L, DeLong ER, Turpie AG, Califf RM, Weatherley B, Cohen M.

Circulation. 1998 May 5;97(17):1702-7. PMID: 9591764 Free Article

Cost effectiveness of inpatient initiation of antiarrhythmic therapy for supraventricular tachycardias.

Simons GR, Eisenstein EL, Shaw LJ, Mark DB, Pritchett EL.

Am J Cardiol. 1997 Dec 15;80(12):1551-7. PMID: 9416934

Economics of treating heart failure.

Mark DB.

Am J Cardiol. 1997 Oct 30;80(8B):33H-38H. Review. PMID: 9372996

Issues of cost-effectiveness in the use of antithrombotic therapy for ischemic heart disease.

Califf RM, Mark DB.

Am Heart J. 1997 Nov;134(5 Pt 2):S88-96. Review. No abstract available. PMID: 9396640

Geographic variation in resource use for coronary artery bypass surgery. IHD Port Investigators.

Cowper PA, DeLong ER, Peterson ED, Lipscomb J, Muhlbaier LH, Jollis JG, Pryor DB, Mark DB.

Med Care. 1997 Apr;35(4):320-33. PMID: 9107202

Economic implications of the prophylactic use of intraaortic balloon counterpulsation in the setting of acute myocardial infarction. The Randomized IABP Study Group. Intraaortic Balloon Pump.

Talley JD, Ohman EM, Mark DB, George BS, Leimberger JD, Berdan LG, Davidson-Ray L, Rawert M, Lam LC, Phillips HR, Califf RM.

Am J Cardiol. 1997 Mar 1;79(5):590-4. PMID: 9068514

Medical care costs and quality of life after randomization to coronary angioplasty or coronary bypass surgery. Bypass Angioplasty Revascularization Investigation (BARI) Investigators.

Hlatky MA, Rogers WJ, Johnstone I, Boothroyd D, Brooks MM, Pitt B, Reeder G, Ryan T, Smith H, Whitlow P, Wiens R, Mark DB.

N Engl J Med. 1997 Jan 9;336(2):92-9. PMID: 8988886 Free Article

Assessing the value of newer pharmacologic agents in non-ST elevation patients: a decision support system application.

Eisenstein EL, Peterson ED, Jollis JG, Tardiff BE, Califf RM, Knight JD, Mark DB.

Proc AMIA Annu Fall Symp. 1997:273-7. PMID: 9357631 Free PMC Article

Importance of cost and quality of life in decisions about routine angiography after acute myocardial infarction. The role of cost-effectiveness models.

Eisenstein EL, Mark DB, Califf RM.

Circulation. 1996 Sep 1;94(5):869-71. No abstract available. PMID: 8790017 Free Article

Economic assessment of platelet glycoprotein IIb/IIIa inhibition for prevention of ischemic complications of high-risk coronary angioplasty. EPIC Investigators.

Mark DB, Talley JD, Topol EJ, Bowman L, Lam LC, Anderson KM, Jollis JG, Cleman MW, Lee KL, Aversano T, Untereker WJ, Davidson-Ray L, Califf RM.

Circulation. 1996 Aug 15;94(4):629-35. PMID: 8772681 Free Article

Implications of cost in treatment selection for patients with coronary heart disease.

Mark DB.

Ann Thorac Surg. 1996 Feb;61(2 Suppl):S12-5; discussion S33-4. PMID: 8572825

Economics and Quality of Life After Acute Myocardial Infarction: Insights from GUSTO-I.

Mark DB.

J Thromb Thrombolysis. 1996;3(2):151-155. PMID: 10602556

Frequency, significance, and cost of recurrent ischemia after thrombolytic therapy for acute myocardial infarction. TAMI Study Group.

Barbagelata A, Granger CB, Topol EJ, Worley SJ, Kereiakes DJ, George BS, Ohman EM, Leimberger JD, Mark DB, Califf RM.

Am J Cardiol. 1995 Nov 15;76(14):1007-13. PMID: 7484852

Clinical and economic lessons from studies of coronary thrombolysis.

Mark DB.

J Vasc Interv Radiol. 1995 Nov-Dec;6(6 Pt 2 Suppl):94S-101S. Review. PMID: 8770850

Baseline and 6-month costs of primary angioplasty therapy for acute myocardial infarction: results from the primary angioplasty registry.

Mark DB, O’Neill WW, Brodie B, Ivanhoe R, Knopf W, Taylor G, O’Keefe JH, Grines CL, Davidson-Ray L, Knight JD, et al.

J Am Coll Cardiol. 1995 Sep;26(3):688-95. PMID: 7642860 Free Article

Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction.

Mark DB, Hlatky MA, Califf RM, Naylor CD, Lee KL, Armstrong PW, Barbash G, White H, Simoons ML, Nelson CL.

N Engl J Med. 1995 May 25;332(21):1418-24. Erratum in: N Engl J Med 1995 Jul 27;333(4):267. PMID: 7723799 Free Article

Use of medical resources and quality of life after acute myocardial infarction in Canada and the United States.

Mark DB, Naylor CD, Hlatky MA, Califf RM, Topol EJ, Granger CB, Knight JD, Nelson CL, Lee KL, Clapp-Channing NE, et al.

N Engl J Med. 1994 Oct 27;331(17):1130-5. PMID: 7935638 Free Article

Costs of interventional cardiac procedures.

Mark DB.

J Interv Cardiol. 1994 Aug;7(4):369-78. No abstract available. PMID: 10151067

Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research.

Jollis JG, Ancukiewicz M, DeLong ER, Pryor DB, Muhlbaier LH, Mark DB.

Ann Intern Med. 1993 Oct 15;119(8):844-50. PMID: 8018127

Comparison of analytic models for estimating the effect of clinical factors on the cost of coronary artery bypass graft surgery.

Dudley RA, Harrell FE Jr, Smith LR, Mark DB, Califf RM, Pryor DB, Glower D, Lipscomb J, Hlatky M.

J Clin Epidemiol. 1993 Mar;46(3):261-71. PMID: 8455051

Resource use and cost of initial coronary revascularization. Coronary angioplasty versus coronary bypass surgery.

Hlatky MA, Lipscomb J, Nelson C, Califf RM, Pryor D, Wallace AG, Mark DB.

Circulation. 1990 Nov;82(5 Suppl):IV208-13. PMID: 2225406

Feasibility and cost-saving potential of outpatient cardiac catheterization.

Lee JC, Bengtson JR, Lipscomb J, Bashore TM, Mark DB, Califf RM, Pryor DB, Hlatky MA.

J Am Coll Cardiol. 1990 Feb;15(2):378-84. PMID: 2299080