[Variations among Spanish regions in the use of three cardiovascular technologies]

There is evidence that some geographic variations in the use of medical technologies are not explained by differences in disease burden. The objectives of this study were to quantify variability in the use of percutaneous coronary intervention (PCI), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) in Spanish autonomous regions and to try to explain the variability found for the first two technologies.

Linear regression models were developed in which the number of procedures performed per million population (pmp) in 2003 in each autonomous region was the dependent variable. Independent variables used included indices of technology provision, regional wealth, and disease burden.

For PCI, the mean utilization rate for the whole of Spain was 1038 procedures pmp, with a high-low ratio of 1.95. Differences in gross domestic product explained 21% of the variability, but there was no relationship between the number of procedures performed and disease burden. For ICDs, the mean number of procedures performed in the whole of Spain was 46 pmp, with a high-low ratio of 3.04. As for PCI, differences in regional wealth explained 40% of the variability, with disease burden making no contribution. For CRT, the mean number of procedures performed in Spain in 2003 was 15 pmp, with a high-low ratio of 15.7.

The considerable regional variation that exists in the use of these three medical technologies is principally explained by differences in regional wealth and not in disease burden.