Managed Care

 

Clinical and Economic Effects of Coronary Restenosis After Percutaneous Coronary Intervention in a Managed Care Population

MANAGED CARE April 2005. © MediMedia USA
Peer-Reviewed

Clinical and Economic Effects of Coronary Restenosis After Percutaneous Coronary Intervention in a Managed Care Population

This study is the first to estimate costs and medical resource use associated with restenosis involving bare metal stents in managed care percutaneous coronary intervention patients.
Mary Ann Clark, MHA
Department of Health Economics and Outcomes Research, Boston Scientific Corp., Natick, Mass.
MANAGED CARE April 2005. ©MediMedia USA

This study is the first to estimate costs and medical resource use associated with restenosis involving bare metal stents in managed care percutaneous coronary intervention patients.

Mary Ann Clark, MHA

Department of Health Economics and Outcomes Research, Boston Scientific Corp., Natick, Mass.

Ameet Bakhai, MD, MRCP

Division of Cardiology, Beth Israel Deaconess Medical Center, Boston; Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London

Elise M. Pelletier, MS

Department of Health Economics and Outcomes Research, Boston Scientific Corp., Natick, Mass.

David J. Cohen, MD, MSc

Division of Cardiology, Beth Israel Deaconess Medical Center, Boston; Department of Health Policy and Management, Harvard School of Public Health, Boston

ABSTRACT

Purpose: The epidemiology of coronary restenosis after percutaneous coronary intervention (PCI) has been documented extensively in clinical trials, but no data exist on the clinical and economic burden of restenosis in a managed care population.

Design: Retrospective cohort with a nationally representative managed care claims database (IHCIS, Waltham, Mass.) representing 2.8 million members.

Methodology: Patients undergoing initial PCI between 1/1/00 and 12/31/00 (N=3,258) were identified and followed to 1 year. Clinical events, resource use, and costs between 1 month and 1 year after the initial PCI were identified. The clinical restenosis rate was estimated by multiplying the observed repeat revascularization rate by 0.85, based on previously published studies. All costs are reported from a managed care perspective in Year 2000 dollars.

Principal findings: Overall, 14.7 percent of patients required 1 or more repeat revascularization procedures between 1 month and 1 year after initial PCI, which implies an estimated clinical restenosis rate of 12.5 percent. Mean 1-year costs were nearly 6-fold higher among patients with and without repeat revascularization ($31,954 ± $31,857 vs. $5,474 ± $12,006, P<.001). After adjusting for baseline imbalances, the independent incremental cost for each patient with repeat revascularization was $24,955 (95 percent confidence interval, $23,401–$26,510). Annual follow-up costs attributable to restenosis were $3,118 per initial PCI recipient (i.e., $24,955 × 12.5 percent).

Conclusion: Clinical restenosis occurred in approximately 12.5 percent of real-world managed care PCI patients and increased health care costs by an average of $3,118 per patient. These findings have important implications for the cost-effectiveness of new treatments that substantially reduce restenosis.

Key terms: restenosis, stent, cost-effectiveness, managed care, costs, epidemiology

Author correspondence:
Mary Ann Clark
1 Boston Scientific Place
Mailstop CP-4
Natick, MA 01760

This study was made possible through a grant from Boston Scientific Corp.

Mary Ann Clark, MHA, and Elise M. Pelletier, MS, are employees and shareholders in Boston Scientific Corp. Ameet Bakhai, MD, and David J. Cohen, MD, MSc, are paid consultants for Boston Scientific Corp.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014