Research Comparative Effectiveness Research United States (US) healthcare expenditure has continued to grow over the past three decades, despite the promise that improved resource allocation, biomedical research and technology would improve both efficiency and outcomes. Current estimates from the United States Congressional Budget Office (CBO) estimate that 4 percent of the 2007 Gross Domestic Product (GDP) was allocated to Medicare and Medicaid. This amount is estimated to grow to up to 20 percent of the federal budget by 2050 if current projections remain true. Thus, healthcare expenditure is quickly becoming the most significant factor in the already strained United States federal budget. Payment for the treatment of peripheral arterial disease (PAD) represents a significant amount of healthcare resource allocation. In 2007, the United States spent 151 billion dollars in direct and indirect costs for the treatment of 12 million beneficiaries with PAD. It is clear that these current trends are untenable within the constraints of the economic system. Vascular care is likely to become increasingly important, as the overall population ages. It will become paramount to evaluate the appropriate treatment of each patient with vascular disease within the overall context of the national healthcare system. Comparative effectiveness research (CER) must provide the scientific basis for this process. Simply put, comparative effectiveness is the study of two or more treatment options to address a given medical condition. Within the domain of vascular disease, there is an ever-increasing array of options and modalities to address our patient’s disease processes. Many of these new modalities compete with either non-operative management or traditional operative techniques, and have not been fully evaluated with respect to efficacy and healthcare economics. The implementation of CER may be ideally suited for mechanisms such as Accountable Care Organizations. Within this construct, patients and providers use evidence-based medicine to decide on clinically and financially treatment courses, and both benefit from maximizing these factors. Within the vascular disease space, this is accomplished by choosing the safest, most efficacious and durable procedure. These factors have begun to translate into the federal regulatory process, as the Food and Drug Administration is now considering patient-centric outcomes for new device approvals. Dr. Stoner is actively involved in CER and value-based research, which is the scientific cornerstone of creating a sustainable healthcare framework. Research includes care process and value proposition optimization for aortic surgery (figure), and a critical analysis of evolving technologies. Cardiovascular Engineering Lab The University of Rochester Medical Center Cardiovascular Engineering Lab (CVEL) involves a cross-disciplinary, multi-institutional team working towards solving cardiovascular problems using engineering principles. The overall theme of this lab is solving little problems, using the expertise of staff and students from various backgrounds, in order to solve the bigger problems in this field. The cardiovascular system is governed by forces prevalent in engineering, and the team of clinicians and engineers work together on problems faced in the cardiovascular field which can be solved through the application of engineering.