Cost of Care for New-Onset ACS Patients
Objectives: This study examines demographic, health characteristics, and total health care utilization in acute coronary syndrome (ACS) patients who underwent coronary revascularization within the first year of follow-up.
Background: Revascularization during or after the index ACS event is becoming more common, and it is important to further characterize these patients.
Methods: A retrospective claims analysis was conducted (7/1/1999-6/30/2001) with new onset ACS patients, defined as an emergency room visit or hospitalization with an ICD-9 code for unstable angina (UA) or acute myocardial infarction (AMI), but without an ACS claim in the previous 6 months. Patients were followed up to 12 months to identify total resource utilization (medical, pharmacy, revascularization procedures).
Results: A total of 6,929 patients were included and 69% had revascularization performed during the index hospitalization. Mean age was 55 years; 72.9% were male. Revascularization was percutaneous coronary intervention (PCI) in 5,002 and bypass surgery in 1,927. The index ACS event was AMI in 48.9%; 13.5% had both AMI and UA. Total first-year cost was $210.7 million ($30,402/patient); hospitalization costs were $161.7 million ($23,331/patient). During follow-up, 75.5% received a statin, 75.8% a beta-blocker, and 63.5% of all patients received clopidogrel (84.8% of PCI patients). Mean days of clopidogrel therapy were 83.5.
Conclusions: Early revascularization is a frequent therapeutic strategy in these relatively young managed care patients. The majority of costs were medical and a majority of procedures were PCI. Many patients experienced AMI as their initial cardiovascular event. Drug utilization of statins, beta-blockers, and clopidogrel, according to practice guidelines, was acceptable.
Several U.S.-based studies have estimated the overall cost of illness for acute coronary syndrome (ACS). However, these studies either do not address the costs of care for the growing group of patients who undergo coronary revascularization, or examine the typically younger, commercially-insured population.
The therapeutic approach for the ACS patient is the subject of numerous clinical studies and guidelines. Consensus guidelines now recommend early invasive therapy for the high-risk ACS patients. The frequency of an early invasive strategy in ACS is reflected in data from the American College of Cardiology National Cardiovascular Data Registry indicating that over 60% of percutaneous coronary interventions (PCI) are performed in patients with ACS.
Guidelines for drug use in patients undergoing revascularization, with or without ACS, are available. The 2004 update of coronary artery bypass graft (CABG) surgery guidelines broadly recommends long-term aspirin and statin therapy for appropriate patients in the post-operative phase. Similarly, the 2002 ACS therapy guideline update recommends antiplatelet agents, aggressive lipid and blood pressure management, beta-blockers, and angiotensin-converting enzyme inhibitors in appropriate patients. If patients go on to PCI and receive a stent, there is general agreement that clopidogrel should be initiated and continued for up to 12 months. However, data from the clinical practice setting shows gaps between treatment guidelines and actual practice.
The purpose of this study was to examine healthcare utilization in managed care patients with new-onset ACS who also underwent coronary revascularization within the first year following the index event. The study objectives were to: 1) learn details of the revascularization, such as type, rate, and when it was performed; 2) estimate total health services utilization and cost; and 3) understand patterns of drug therapy use.
Objectives: This study examines demographic, health characteristics, and total health care utilization in acute coronary syndrome (ACS) patients who underwent coronary revascularization within the first year of follow-up.
Background: Revascularization during or after the index ACS event is becoming more common, and it is important to further characterize these patients.
Methods: A retrospective claims analysis was conducted (7/1/1999-6/30/2001) with new onset ACS patients, defined as an emergency room visit or hospitalization with an ICD-9 code for unstable angina (UA) or acute myocardial infarction (AMI), but without an ACS claim in the previous 6 months. Patients were followed up to 12 months to identify total resource utilization (medical, pharmacy, revascularization procedures).
Results: A total of 6,929 patients were included and 69% had revascularization performed during the index hospitalization. Mean age was 55 years; 72.9% were male. Revascularization was percutaneous coronary intervention (PCI) in 5,002 and bypass surgery in 1,927. The index ACS event was AMI in 48.9%; 13.5% had both AMI and UA. Total first-year cost was $210.7 million ($30,402/patient); hospitalization costs were $161.7 million ($23,331/patient). During follow-up, 75.5% received a statin, 75.8% a beta-blocker, and 63.5% of all patients received clopidogrel (84.8% of PCI patients). Mean days of clopidogrel therapy were 83.5.
Conclusions: Early revascularization is a frequent therapeutic strategy in these relatively young managed care patients. The majority of costs were medical and a majority of procedures were PCI. Many patients experienced AMI as their initial cardiovascular event. Drug utilization of statins, beta-blockers, and clopidogrel, according to practice guidelines, was acceptable.
Several U.S.-based studies have estimated the overall cost of illness for acute coronary syndrome (ACS). However, these studies either do not address the costs of care for the growing group of patients who undergo coronary revascularization, or examine the typically younger, commercially-insured population.
The therapeutic approach for the ACS patient is the subject of numerous clinical studies and guidelines. Consensus guidelines now recommend early invasive therapy for the high-risk ACS patients. The frequency of an early invasive strategy in ACS is reflected in data from the American College of Cardiology National Cardiovascular Data Registry indicating that over 60% of percutaneous coronary interventions (PCI) are performed in patients with ACS.
Guidelines for drug use in patients undergoing revascularization, with or without ACS, are available. The 2004 update of coronary artery bypass graft (CABG) surgery guidelines broadly recommends long-term aspirin and statin therapy for appropriate patients in the post-operative phase. Similarly, the 2002 ACS therapy guideline update recommends antiplatelet agents, aggressive lipid and blood pressure management, beta-blockers, and angiotensin-converting enzyme inhibitors in appropriate patients. If patients go on to PCI and receive a stent, there is general agreement that clopidogrel should be initiated and continued for up to 12 months. However, data from the clinical practice setting shows gaps between treatment guidelines and actual practice.
The purpose of this study was to examine healthcare utilization in managed care patients with new-onset ACS who also underwent coronary revascularization within the first year following the index event. The study objectives were to: 1) learn details of the revascularization, such as type, rate, and when it was performed; 2) estimate total health services utilization and cost; and 3) understand patterns of drug therapy use.
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