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
Elise M. Pelletier, MS
Department of Health Economics and Outcomes Research,Boston Scientific Corp.,Natick,Mass.
David J.Cohen, MD, MSc
Department of Health Policy and Management, Harvard School of Public Health, Boston


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.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
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The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.