Doctors at a major cardiology conference said they anticipate more clinical research aimed at determining the cost-effectiveness of drugs and medical devices amid the Obama administration's push to clamp down on health-care spending.

Drug and medical-device makers face increased pressure to show their products won't break the health-care bank, or could even save the system money. Doctors and researchers, meanwhile, realize they have to start thinking more about health costs as well, rather than dodging the topic to avoid the possibility of limiting treatments options.

"Almost every big randomized trial now is going to have a cost-effective arm [to determine] whether our therapies are not only clinically effective, but also cost effective," said Mark Turco, who directs the Center for Cardiac & Vascular Research at Washington Adventist Hospital in Maryland, in an interview on the sidelines of the American College of Cardiology's annual conference.

Top issues at the huge heart meeting have included a debate about whether widening the use of AstraZeneca PLC's (AZN) cholesterol-lowering drug Crestor to ward off heart attacks in apparently healthy people is cost-effective. Another study indicated tiny artery-opening heart stents from Boston Scientific Corp. (BSX) are more cost effective than bypass surgery after one year for patients with significant heart problems.

The debates in both cases built upon previously released studies, but still ranked amid ACC's most closely watched events because of the high interest in such topics.

Some key studies also focused on comparative effectiveness, or a match-up between two treatment methods to see what works best. One showed that a device made by privately held Atritech Inc. that blocks a heart area where clots often form can better protect patients at risk of stroke from a common heart-rhythm disorder than a widely used anti-clotting drug, warfarin, sold by Bristol-Myers Squibb Co. (BMY) under the name Coumadin.

These studies were launched long before President Obama signed a stimulus bill with $1.1 billion aimed at launching more comparative effectiveness research, and also long before the White House issued a budget proposal that aims to cut health spending in some areas. But future heart studies will be built with these ideas in mind.

Ralph Brindis, a cardiologist at Oakland Medical Center in California, and also president-elect of ACC, expects professional societies to fold discussions of cost effectiveness into their guidelines for practicing doctors. This would mark a change for organizations that have shied away from examining cost-effectiveness data because of the unsavory prospect of letting financial considerations determine care.

"If you actually looked at our clinical practice guidelines, to date we've actually - I wouldn't say ignored - but actually have avoided discussing the issue of cost," Brindis said. "I think those days are over."

"I think we're more focused on how much benefit is really there," added Aaron Kugelmass, chief of cardiology at Baystate Medical Center in Springfield, Mass., and the coordinator of this year's scientific program at ACC.

The government's push for research focused on determining optimal treatments for various diseases will likely be related to consideration of costs in some cases. With the population aging and health-care expenditures rapidly ballooning, a cautious review of cost analysis in trials should be a helpful tool.

David Holmes, a cardiologist from the Mayo Clinic who is chairing ACC's meeting for doctors who perform angioplasty, said it would be hard to retrofit studies already underway to include a tighter focus on cost-effectiveness. But he anticipates pressure to include these details in upcoming research.

"It's going to be used because we're going to be held to a higher economic standard," he said.

Douglas Weaver, president of the ACC, set the tone for cost consciousness Sunday morning in a blunt speech in which he challenged his colleagues to use resources more wisely. He said the ACC, for example, has set a goal of reducing inappropriate cardiac imaging procedures by 10% to 15% by 2011.

"We can no longer bring new technologies into practice that provide little incremental improvement in outcomes or safety," Weaver said.

-By Jon Kamp, Dow Jones Newswires; 617-654-6728; jon.kamp@dowjones.com

-Peter Loftus; Dow Jones Newswires; 215-656-8289; peter.loftus@dowjones.com