Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 177
Filtrar
1.
Am J Cardiol ; 123(10): 1602-1609, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30832963

RESUMO

To assess the frequency and costs of revascularization procedures in patients with stable ischemic heart disease (SIHD) initiating ranolazine versus traditional antianginals. Adults (≥18 years) with a diagnosis of SIHD who initiated ranolazine or a traditional antianginal (beta-blocker [BB], calcium channel blocker [CCB], or long-acting nitrate [LAN]) as second or third line therapy between 2008 and 2016, were selected from the IBM MarketScan Databases. Inverse probability weighting based on propensity score was employed to balance the ranolazine and traditional antianginals cohorts on patient clinical characteristics. Outcomes assessed were frequency and total cost of revascularization procedures over a 12-month follow-up. A total of 108,741 patients with SIHD were included. Of these, 18% initiated treatment with ranolazine, 21% received BBs, 24% received CCBs, and 37% were treated with LANs. Revascularization rates were significantly lower in ranolazine patients (11%) than in BB (16%) and LAN (14%) patients (both p <0.001), and more comparable to CCB patients (10%; p = 0.007). Compared with BB and LAN, those in the ranolazine cohort were less likely to have a revascularization procedure during hospitalization and had a shorter length of stay if hospitalized (all p <0.001). The mean healthcare costs associated with revascularization were lower in ranolazine patients ($2,933) than in BB ($4,465) and LAN ($3,609) patients (p <0.001), but similar to CCB patients ($2,753; p = 0.29). In conclusion, ranolazine treatment in patients with SIHD was associated with fewer revascularization procedures and lower associated healthcare costs compared with patients initiating BB or LAN, and comparable to patients initiating CCBs.


Assuntos
Custos de Cuidados de Saúde , Isquemia Miocárdica/terapia , Revascularização Miocárdica/tendências , Nitroglicerina/uso terapêutico , Ranolazina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Preparações de Ação Retardada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/economia , Revascularização Miocárdica/economia , Estudos Retrospectivos , Bloqueadores dos Canais de Sódio/uso terapêutico , Resultado do Tratamento , Estados Unidos , Vasodilatadores/uso terapêutico , Adulto Jovem
3.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 28-34, jan.-fev. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-984525

RESUMO

Coronary artery bypass grafting (CABG) is an important treatment option for obstructive coronary artery disease, but it represents a high expense for paying sources. The complications of CABG impose an additional expense to the procedure that is not yet clearly established. Objective: To determine the economic impact of postoperative complications of CABG during hospitalization in a hospital of the unified health system (SUS). Methods: This is an observational study involving 240 patients undergoing isolated CABG in a reference hospital in cardiology in 2013. Patients aged over 30 years with proven coronary artery disease and indication to perform CRVM were included. Patients who performed CRVM associated with other procedures were excluded. Results: The average cost of hospitalization was R$ 22,647.24 (SD = R$ 28,105.66). In 97 patients who presented some complication the average cost was R$ 35,400.28 (SD = R$ 40,509.47), and in the 143 patients without complications the average cost was R$ 13,996.57 (SD = R$ 5,800.61) (p < 0.001). Expenditures ranged from R$ 17,344.37 in patients with one complication up to R$ 104,596.52 in patients with five complications (p < 0.001). Conclusions: The occurrence of complications during hospitalization for CABG significantly increases the costs of the procedure, but the magnitude of this increase depends on the type of complication developed, and higher expenses related to cardiovascular complications, infections and bleeding. With this information, managers can improve the allocation of resources to health


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Custos Hospitalares/tendências , Hospitalização/economia , Revascularização Miocárdica/economia , Revascularização Miocárdica/métodos , Arritmias Cardíacas/complicações , Cuidados Pós-Operatórios/métodos , Sistema Único de Saúde , Doença da Artéria Coronariana , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/mortalidade , Infecção Hospitalar , Análise Estatística , Estudos Retrospectivos , Análise de Variância
4.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 28-34, jan.-fev. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-981527

RESUMO

Background: Coronary artery bypass grafting (CABG) is an important treatment option for obstructive coronary artery disease, but it represents a high expense for paying sources.The complications of CABG impose an additional expense to the procedure that is not yet clearly established. Objective: To determine the economic impact of postoperative complications of CABG during hospitalization in a hospital of the unified health system (SUS). Methods: This is an observational study involving 240 patients undergoing isolated CABG in a reference hospital in cardiology in 2013. Patients aged over 30 years with proven coronary artery disease and indication to perform CRVM were included. Patients who performed CRVM associated with other procedures were excluded. Results: The average cost of hospitalization was R$ 22,647.24 (SD = R$ 28,105.66). In 97 patients who presented some complication the average cost was R$ 35,400.28 (SD = R$ 40,509.47), and in the 143 patients without complications the average cost was R$ 13,996.57 (SD = R$ 5,800.61) (p < 0.001). Expenditures ranged from R$ 17,344.37 in patients with one complication up to R$ 104,596.52 in patients with five complications (p < 0.001). Conclusions: The occurrence of complications during hospitalization for CABG dignificantly increases the costs of the procedure, but the magnitude of this increase depends on the type of complication developed, and higher expenses related to cardiovascular complications, infections and bleeding. With this information, managers can improve the allocation of resources to health


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hospitalização/economia , Revascularização Miocárdica/economia , Revascularização Miocárdica/métodos , Arritmias Cardíacas/complicações , Cuidados Pós-Operatórios/métodos , Sistema Único de Saúde , Doença da Artéria Coronariana , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/mortalidade , Infecção Hospitalar , Análise Estatística , Estudos Retrospectivos , Análise de Variância
5.
Circ Cardiovasc Qual Outcomes ; 11(6): e004492, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29903936

RESUMO

BACKGROUND: Because specialty care accounts for half of Medicare expenditures, improving its value is critical to the success of Medicare accountable care organizations (ACOs) in curbing spending growth. However, whether ACOs have reduced low-value specialty care without compromising use of high-value services remains unknown. METHODS AND RESULTS: Using national Medicare data, we identified 2 cohorts: beneficiaries for whom the value of coronary revascularization is lower (those with ischemic heart disease without angina, congestive heart failure, or recent admission for acute myocardial infarction) and beneficiaries for whom its value is higher (those with recent acute myocardial infarction admission). We then determined the provider groups who cared for the cohorts, distinguishing between those participating (n=298) and those not participating in a Medicare ACO (1329). After measuring the provider groups' use of coronary artery bypass grafting and percutaneous coronary intervention among the 2 cohorts, we fit multivariable models to test the statistical significance of rates of change in low- and high-value revascularization after ACO participation. During the pre-ACO period, participating and nonparticipating provider groups had similar rates of low- and high-value revascularization. Our multivariable model results show that rates of change for low- and high-value coronary revascularization were not altered by a provider group's participation in a Medicare ACO (lower value: difference, -0.04 per year; 95% confidence interval, -0.11 to 0.03; higher value: difference, 0.96 per year; 95% confidence interval, -0.46 to 2.4). CONCLUSIONS: We found no association between provider group participation in a Medicare ACO and use of low- or high-value coronary revascularization.


Assuntos
Organizações de Assistência Responsáveis/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Medicare/economia , Isquemia Miocárdica/economia , Isquemia Miocárdica/terapia , Revascularização Miocárdica/economia , Padrões de Prática Médica/economia , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/tendências , Humanos , Masculino , Modelos Econômicos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Revascularização Miocárdica/tendências , Padrões de Prática Médica/tendências , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
6.
Int. j. cardiovasc. sci. (Impr.) ; 31(2): f:90-l:96, mar.-abr. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-881923

RESUMO

Background: Cardiovascular diseases are a major cause of mortality and morbidity. Myocardial revascularization surgery may be indicated for the relief of symptoms and to reduce mortality. However, surgery is a costly procedure and the impact of the number of cardiovascular risk factors on the cost of the procedure has not been established. Objectives: To identify the impact of risk factors for coronary artery disease on myocardial revascularization surgery cost. Methods: We selected 239 patients undergoing myocardial revascularization surgery at the National Institute of Cardiology in the period from 01 January to 31 December 2013. We included patients aged over 30 years, with indication for the procedure. Patients undergoing combined procedures were excluded. Results: Seven patients had only one risk factor, 32 patients had two risk factors, 75 patients had 3 risk factors, 78 patients had four risk factors, 36 patients had 5 risk factors and 11 patients presented 6 risk factors. The total costs, on average, was R$ 14,143.22 in the group with 1 risk factor, R$ 18,380.40 in the group with 2 risk factors, R$ 21,229.51 in the group with 3 risk factors, R$ 24,620.86 in the group with 4 risk factors, R$ 21,337.92 in the group with 5 risk factors and R$ 36,098,35 in the group with 6 risk factors (p = 0.441). Conclusion: This study demonstrates that, in a public referral center for highly complex cardiology procedures, there was no significant correlation between the number of cardiovascular risk factors and hospitalization costs


Fundamentos: As doenças cardiovasculares representam uma importante causa de mortalidade e morbidade. A cirurgia de revascularização do miocárdio pode ser indicada para o alívio dos sintomas e para diminuir a mortalidade. Entretanto, a cirurgia é um procedimento de custo elevado e não está estabelecido o impacto do número de fatores de risco cardiovasculares nos gastos do procedimento. Objetivos: Identificar o impacto dos fatores de risco para a doença arterial coronariana nos gastos com a cirurgia de revascularização do miocárdio. Métodos: Foram selecionados 239 pacientes submetidos à cirurgia de revascularização do miocárdio isolada no Instituto Nacional de Cardiologia no período entre 01 de Janeiro a 31 de Dezembro de 2013. Foram incluídos pacientes com idade superior a 30 anos e indicação de revascularização cirúrgica do miocárdio. Foram excluídos os pacientes submetidos a procedimentos combinados. Resultados: Sete pacientes apresentaram apenas 1 fator de risco, 32 pacientes apresentaram 2 fatores de risco, 75 pacientes apresentaram 3 fatores de risco, 78 pacientes apresentaram 4 fatores de risco, 36 pacientes apresentaram 5 fatores de risco e 11 pacientes apresentaram 6 fatores de risco. O total dos gastos, em média, foi de R$ 14 143,22 no grupo com 1 fator de risco, R$ 18 380,40 no grupo com 2 fatores de risco, R$ 21 229,51 no grupo com 3 fatores de risco, R$ 24 620,86 no grupo com 4 fatores de risco, R$ 21 337,92 no grupo com 5 fatores de risco e R$ 36 098,35 no grupo com 6 fatores de risco (p = 0,441). Conclusão: Este trabalho demonstra que, em uma unidade pública de referência para a realização de procedimentos cardiológicos de alta complexidade, não houve uma correlação significativa entre o número de fatores de risco cardiovascular e os custos da internação


Assuntos
Humanos , Masculino , Feminino , Doença da Artéria Coronariana/mortalidade , Custos Hospitalares , Revascularização Miocárdica/economia , Revascularização Miocárdica/métodos , Fatores de Risco , Sistema Único de Saúde , Brasil , Comorbidade , Diabetes Mellitus/diagnóstico , Custos de Medicamentos , Hipertensão/complicações , Prevalência , Estudos Prospectivos , Função Ventricular Esquerda
7.
JAMA Cardiol ; 3(2): 133-141, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29299607

RESUMO

Importance: The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. Objectives: To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Design, Setting, and Participants: Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment. The setting was VA and CC hospitals. Participants were veterans undergoing elective percutaneous coronary intervention (PCI) and veterans undergoing coronary artery bypass graft (CABG) procedures between October 1, 2008, and September 30, 2011. The analysis was conducted between July 2014 and July 2017. Exposures: Receipt of an elective coronary revascularization at a VA vs CC facility. Main Outcomes and Measures: Access to care as measured by travel distance, 30-day mortality, and costs. Results: In the 3 years ending on September 30, 2011, a total of 13 237 elective PCIs (79.1% at the VA) and 5818 elective CABG procedures (83.6% at the VA) were performed in VA or CC hospitals among veterans meeting study inclusion criteria. On average, use of CC was associated with reduced net travel by 53.6 miles for PCI and by 73.3 miles for CABG surgery compared with VA-only care. Adjusted 30-day mortality after PCI was higher in CC compared with VA (1.54% for CC vs 0.65% for VA, P < .001) but was similar after CABG surgery (1.33% for CC vs 1.51% for VA, P = .74). There were no differences in adjusted 30-day readmission rates for PCI (7.04% for CC vs 7.73% for VA, P = .66) or CABG surgery (8.13% for CC vs 7.00% for VA, P = .28). The mean adjusted PCI cost was higher in CC ($22 025 for CC vs $15 683 for VA, P < .001). The mean adjusted CABG cost was lower in CC ($55 526 for CC vs $63 144 for VA, P < .01). Neither procedural volume nor publicly reported mortality data identified hospitals that provided higher-value care with the exception that CABG mortality was lower in small-volume CC hospitals. Conclusions and Relevance: In this veteran cohort, PCIs performed in CC hospitals were associated with shorter travel distance but with higher mortality, higher costs, and minimal travel savings compared with VA hospitals. The CABG procedures performed in CC hospitals were associated with shorter travel distance, similar mortality, and lower costs. As the VA considers expansion of the CC program, ongoing assessments of value and access gains are essential to optimize veteran outcomes and VA spending.


Assuntos
Ponte de Artéria Coronária/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Revascularização Miocárdica/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Adulto , Idoso , Estudos de Coortes , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/normas , Serviços de Saúde Comunitária/estatística & dados numéricos , Ponte de Artéria Coronária/economia , Ponte de Artéria Coronária/normas , Custos e Análise de Custo , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/economia , Revascularização Miocárdica/normas , Readmissão do Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea/economia , Intervenção Coronária Percutânea/normas , Qualidade da Assistência à Saúde , Viagem , Estados Unidos , United States Department of Veterans Affairs
8.
Eur Heart J Qual Care Clin Outcomes ; 3(1): 74-82, 2017 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-28927186

RESUMO

Aims: This study is a prospective, observational 8-year follow-up of 300 stable unselected coronary artery disease patients entering elective coronary angiography in 2002-03. Recorded were clinical outcomes, health-related quality of life (HRQoL), and secondary care costs after coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), or medical therapy (MT). Methods and results: HRQoL was measured by the 15D instrument at baseline, 6 months, and 8 years. Regression techniques with an adjustment for relevant baseline characteristics were used to compare the 8-year survival and change in HRQoL between the groups. At baseline, all groups had statistically significantly impaired HRQoL compared with age- and gender-standardized general population. Six months after invasive interventions the mean HRQoL score had improved in a statistically significant and clinically important manner. This improvement was maintained at 8 years as the HRQoL no longer differed from that of the general population, whereas MT patients were still worse off. However, after adjustment for baseline characteristics, the groups no longer differed regarding 8-year survival or change in HRQoL among survivors. Mean 8-year secondary care costs were without (with) adjustment for baseline characteristics: €17 498 (16 730) for CABG, €7245 (6920) for PCI, and €4514 (4580) for MT, respectively. Conclusion: When adjusted for baseline characteristics, no statistically significant differences were found between the patient groups in 8-year survival or change in HRQoL among survivors. The 8-year mean secondary care costs of CABG were over two-fold and almost four-fold, even after adjustment for baseline characteristics, compared with those of PCI and MT.


Assuntos
Doença da Artéria Coronariana/terapia , Revascularização Miocárdica/métodos , Qualidade de Vida , Terapia Trombolítica/métodos , Idoso , Doença da Artéria Coronariana/economia , Doença da Artéria Coronariana/psicologia , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/economia , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários , Terapia Trombolítica/economia , Fatores de Tempo , Resultado do Tratamento
9.
Value Health ; 20(6): 745-751, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28577691

RESUMO

OBJECTIVES: To determine the cost-effectiveness of complete revascularization at index admission compared with infarct-related artery (IRA) treatment only, in patients with multivessel disease undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction. METHODS: An economic evaluation of a multicenter randomized trial was conducted, comparing complete revascularization at index admission to IRA-only P-PCI in patients with multivessel disease (12-month follow-up). Overall hospital costs (costs for P-PCI procedure(s), hospital length of stay, and any subsequent re-admissions) were estimated. Outcomes were major adverse cardiac events (MACEs, a composite of all-cause death, recurrent myocardial infarction, heart failure, and ischemia-driven revascularization) and quality-adjusted life-years (QALYs) derived from the three-level EuroQol five-dimensional questionnaire. Multiple imputation was undertaken. The mean incremental cost and effect, with associated 95% confidence intervals, the incremental cost-effectiveness ratio, and the cost-effectiveness acceptability curve were estimated. RESULTS: On the basis of 296 patients, the mean incremental overall hospital cost for complete revascularization was estimated to be -£215.96 (-£1390.20 to £958.29), compared with IRA-only, with a per-patient mean reduction in MACEs of 0.170 (0.044 to 0.296) and a QALY gain of 0.011 (-0.019 to 0.041). According to the cost-effectiveness acceptability curve, the probability of complete revascularization being cost-effective was estimated to be 72.0% at a willingness-to-pay threshold value of £20,000 per QALY. CONCLUSIONS: Complete revascularization at index admission was estimated to be more effective (in terms of MACEs and QALYs) and cost-effective (overall costs were estimated to be lower and complete revascularization thereby dominated IRA-only). There was, however, some uncertainty associated with this decision.


Assuntos
Doença da Artéria Coronariana/cirurgia , Custos Hospitalares/estatística & dados numéricos , Revascularização Miocárdica/métodos , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Doença da Artéria Coronariana/economia , Doença da Artéria Coronariana/patologia , Análise Custo-Benefício , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/economia , Intervenção Coronária Percutânea/economia , Probabilidade , Anos de Vida Ajustados por Qualidade de Vida , Infarto do Miocárdio com Supradesnível do Segmento ST/economia , Infarto do Miocárdio com Supradesnível do Segmento ST/patologia , Inquéritos e Questionários
11.
Circ Cardiovasc Imaging ; 9(10)2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27894070

RESUMO

BACKGROUND: Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance (stress-CMR) are suitable tools for diagnosing obstructive coronary artery disease in symptomatic patients with previous history of revascularization. However, performance appraisal of noninvasive tests must take in account the consequent diagnostic testing, invasive procedures, clinical outcomes, radiation exposure, and cumulative costs rather than their diagnostic accuracy only. We aimed to compare an anatomic (cTCA) versus a functional (stress-CMR) strategy in symptomatic patients with previous myocardial revascularization procedures. METHODS AND RESULTS: Six hundred patients with chest pain and previous revascularization included in a prospective observational registry and evaluated by clinically indicated cTCA (n=300, mean age 68.2±9.7 years, male 255) or stress-CMR (n=300, mean age 67.6±9.7 years, male 263) were enrolled and followed-up in terms of subsequent noninvasive tests, invasive coronary angiography, revascularization procedures, cumulative effective radiation dose, major adverse cardiac events, defined as a composite end point of nonfatal myocardial infarction and cardiac death, and medical costs. The mean follow-up for cTCA and stress-CMR groups was similar (773.6±345 versus 752.8±291 days; P=0.21). Compared with stress-CMR, cTCA was associated with a higher rate of subsequent noninvasive tests (28% versus 17%; P=0.0009), invasive coronary angiography (31% versus 20%; P=0.0009), and revascularization procedures (24% versus 16%; P=0.007). Stress-CMR strategy was associated with a significant reduction of radiation exposure and cumulative costs (59% and 24%, respectively; P<0.001). Finally, patients undergoing stress-CMR showed a lower rate of major adverse cardiac events (5% versus 10%; P<0.010) and cost-effectiveness ratio (119.98±250.92 versus 218.12±298.45 Euro/y; P<0.001). CONCLUSIONS: Compared with cTCA, stress-CMR is more cost-effective in symptomatic revascularized patients.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Revascularização Miocárdica , Vasodilatadores/administração & dosagem , Idoso , Causas de Morte , Angiografia por Tomografia Computadorizada/economia , Angiografia Coronária/economia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/economia , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/fisiopatologia , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Itália , Imagem por Ressonância Magnética/economia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/economia , Revascularização Miocárdica/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Doses de Radiação , Exposição à Radiação , Sistema de Registros , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Vasodilatadores/economia
12.
BMC Cardiovasc Disord ; 16: 13, 2016 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-26769473

RESUMO

BACKGROUND: Annual direct costs for cardiovascular (CV) diseases in the United States are approximately $195.6 billion, with many high-risk patients remaining at risk for major cardiovascular events (CVE). This study evaluated the direct clinical and economic burden associated with new CVE up to 3 years post-event among patients with hyperlipidemia. METHODS: Hyperlipidemic patients with a primary inpatient claim for new CVE (myocardial infarction, unstable angina, ischemic stroke, transient ischemic attack, coronary artery bypass graft, percutaneous coronary intervention and heart failure) were identified using IMS LifeLink PharMetrics Plus data from January 1, 2006 through June 30, 2012. Patients were stratified by CV risk into history of CVE, modified coronary heart disease risk equivalent, moderate- and low-risk cohorts. Of the eligible patients, propensity score matched 243,640 patients with or without new CVE were included to compare healthcare resource utilization and direct costs ranging from the acute (1-month) phase through 3 years post-CVE date (follow-up period). RESULTS: Myocardial infarction was the most common CVE in all the risk cohorts. During the acute phase, among patients with new CVE, the average incremental inpatient length of stay and incremental costs ranged from 4.4-6.2 days and $25,666-$30,321, respectively. Acute-phase incremental costs accounted for 61-75% of first-year costs, but incremental costs also remained high during years 2 and 3 post-CVE. CONCLUSIONS: Among hyperlipidemic patients with new CVE, healthcare utilization and costs incurred were significantly higher than for those without CVE during the acute phase, and remained higher up to 3 years post-event, across all risk cohorts.


Assuntos
Angina Instável/economia , Custos de Cuidados de Saúde , Insuficiência Cardíaca/economia , Hiperlipidemias/economia , Ataque Isquêmico Transitório/economia , Infarto do Miocárdio/economia , Revascularização Miocárdica/economia , Acidente Vascular Cerebral/economia , Adolescente , Adulto , Idoso , Angina Instável/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Ponte de Artéria Coronária/economia , Ponte de Artéria Coronária/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Hiperlipidemias/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Revascularização Miocárdica/estatística & dados numéricos , Intervenção Coronária Percutânea/economia , Intervenção Coronária Percutânea/estatística & dados numéricos , Pontuação de Propensão , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
13.
J Cardiovasc Magn Reson ; 18: 3, 2016 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-26754743

RESUMO

BACKGROUND: Coronary artery disease (CAD) continues to be one of the top public health burden. Perfusion cardiovascular magnetic resonance (CMR) is generally accepted to detect CAD, while data on its cost effectiveness are scarce. Therefore, the goal of the study was to compare the costs of a CMR-guided strategy vs two invasive strategies in a large CMR registry. METHODS: In 3'647 patients with suspected CAD of the EuroCMR-registry (59 centers/18 countries) costs were calculated for diagnostic examinations (CMR, X-ray coronary angiography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive CXA and revascularization at the discretion of the treating physician (=CMR + CXA-strategy). In the hypothetical invasive arm, costs were calculated for an initial CXA and a FFR in vessels with ≥50% stenoses (=CXA + FFR-strategy) and the same proportion of revascularizations and complications were applied as in the CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA and for revascularizations of all ≥50% stenoses. To calculate the proportion of patients with ≥50% stenoses, the stenosis-FFR relationship from the literature was used. Costs of the three strategies were determined based on a third payer perspective in 4 healthcare systems. RESULTS: Revascularizations were performed in 6.2%, 4.5%, and 12.9% of all patients, patients with atypical chest pain (n = 1'786), and typical angina (n = 582), respectively; whereas complications (=all-cause death and non-fatal infarction) occurred in 1.3%, 1.1%, and 1.5%, respectively. The CMR + CXA-strategy reduced costs by 14%, 34%, 27%, and 24% in the German, UK, Swiss, and US context, respectively, when compared to the CXA + FFR-strategy; and by 59%, 52%, 61% and 71%, respectively, versus the CXA-only strategy. In patients with typical angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German (2.3%), intermediate in the US and Swiss (11.6% and 12.8%, respectively), and remained substantial in the UK (18.9%) systems. Sensitivity analyses proved the robustness of results. CONCLUSIONS: A CMR + CXA-strategy for patients with suspected CAD provides substantial cost reduction compared to a hypothetical CXA + FFR-strategy in patients with low to intermediate disease prevalence. However, in the subgroup of patients with typical angina, cost savings were only minimal to moderate.


Assuntos
Cateterismo Cardíaco/economia , Angiografia Coronária/economia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/economia , Doença da Artéria Coronariana/terapia , Técnicas de Apoio para a Decisão , Custos de Cuidados de Saúde , Imagem por Ressonância Magnética/economia , Imagem de Perfusão do Miocárdio/economia , Revascularização Miocárdica/economia , Tomografia Computadorizada por Raios X/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/diagnóstico , Angina Pectoris/economia , Angina Pectoris/terapia , Angiografia Coronária/métodos , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Redução de Custos , Análise Custo-Benefício , Europa (Continente)/epidemiologia , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Imagem de Perfusão do Miocárdio/métodos , Revascularização Miocárdica/efeitos adversos , Seleção de Pacientes , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Sistema de Registros , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
14.
J Cardiothorac Vasc Anesth ; 30(1): 12-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26597467

RESUMO

OBJECTIVES: To compare the direct costs of the index hospitalization and 30-day morbidity and mortality incurred during robotic and conventional coronary artery bypass grafting at a single institution based on hospital clinical and financial records. DESIGN: Retrospective study, propensity-matched groups with one-to-one nearest neighbor matching. SETTING: University hospital, a tertiary care center. PARTICIPANTS: Two thousand eighty-eight consecutive patients who underwent primary coronary artery bypass grafting (CABG) from January 2007 to March 2012. INTERVENTIONS: One hundred forty-one matched pairs were created and analyzed. MEASUREMENTS AND MAIN RESULTS: Robotic CABG was associated with a decrease in operative time (5.61±1.1 v 6.6±1.15 hours, p<0.001), a lower need for blood transfusion (12.8% v 22.6%, p = 0.04), a shorter length of stay (6 [4-9]) v 7 [5-11] days, p = 0.001), a shorter ICU stay (31 [24-49] hours v 52 [32-96.5] hours, p<0.001) and lower NY state complications composite rate (4.26% v 13.48%, p = 0.01). In spite of that, the cost of robotic procedures was not significantly different from matched conventional cases ($18,717.35 [11,316.1-34,550.6] versus $18,601 [13,137-50,194.75], p = 0.13), except 26 hybrid coronary revascularizations in which angioplasty was performed on the same admission (hybrid 25,311.1 [18,537.1-41,167.85] versus conventional 18,966.13 [13,337.75-56,021.75], p = 0.02). CONCLUSION: Robotically assisted CABG does not increase the cost of the index hospitalization when compared to conventional CABG unless hybrid revascularization is performed on the same admission.


Assuntos
Ponte de Artéria Coronária/economia , Doença da Artéria Coronariana/economia , Doença da Artéria Coronariana/cirurgia , Custos Hospitalares , Hospitalização/economia , Procedimentos Cirúrgicos Robóticos/economia , Idoso , Ponte de Artéria Coronária/tendências , Feminino , Custos Hospitalares/tendências , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/economia , Revascularização Miocárdica/tendências , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/tendências
15.
Curr Opin Cardiol ; 30(6): 619-23, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26398552

RESUMO

PURPOSE OF REVIEW: Cost-effectiveness has become an increasingly important tool in assessing the value of healthcare. The principles of cost-effectiveness and the need to standardize the methodology are discussed. Documented variation could be used to adjust reimbursement. RECENT FINDINGS: The US healthcare system continues to be under financial pressure. Although national health expenditures have slowed, growth rates continue to outpace gross domestic product. Spending in the coming years is expected to grow 7% annually. Treatment of cardiac disease, and in particular ischemic heart disease, is a significant portion of healthcare spending. A strategy to improve clinical and financial outcomes for revascularization procedures is essential. Recently, the SYNTAX trial and ASCERT have addressed cost-effectiveness as an outcome measure in revascularization for coronary artery disease. SUMMARY: Cost-effectiveness is becoming an important part of healthcare provider performance and patient outcomes. Difficulties in obtaining cost, resource use, and quality of life data are not insurmountable as recently documented in randomized and observational trials. Reimbursement has already been linked to costs and resource use in current regulation. As the payment systems move toward disease management, cost-effectiveness will be the measure of choice. The prevalence of cardiac disease in the US population will mandate its use in adjusting payments to these providers.


Assuntos
Doença da Artéria Coronariana/economia , Doença da Artéria Coronariana/cirurgia , Custos de Cuidados de Saúde/tendências , Revascularização Miocárdica/economia , Análise Custo-Benefício , Humanos , Estados Unidos
16.
Medicine (Baltimore) ; 93(28): e287, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25526465

RESUMO

Issues regarding healthcare disparity continue to increase in connection with access to quality care for acute myocardial infarction (AMI), even though the case-fatality rate (CFR) continues to decrease. We explored regional variation in AMI CFRs and examined whether the variation was due to disparities in access to quality medical services for AMI patients. A dataset was constructed from the Korea National Health Insurance Claims Database to conduct a retrospective cohort study of 95,616 patients who were admitted to a hospital in Korea from 2003 to 2007 with AMI. Each patient was followed in the claims database for information about treatment after admission or death. The procedure rate decreased as the region went "down" from Seoul to the county level, whereas the AMI CFR increased as the county level as a function of proximity to the county level (30-day AMI CFRs: Seoul, 16.4%; metropolitan areas, 16.2%, cities; 18.8%, counties, 39.4%). Even after adjusting for covariates, an identical regional variation in the odds of patients receiving treatment services and dying was identified. After adjusting for invasive and medical management variables in addition to earlier covariates, the death risk in the counties remained statistically significantly higher than in Seoul; however, the degree of the difference decreased greatly and the significant differences in metropolitan areas and cities disappeared. Policy interventions are needed to increase access to quality AMI care in county-level local areas because regional differences in the AMI CFR are likely caused by differences in the performance of medical and invasive management among the regions of Korea. Additionally, a public education program to increase the awareness of early symptoms and the necessity of visiting the hospital early should be established as the first priority to improve the outcome of AMI patents, especially in county-level local areas.


Assuntos
Formulário de Reclamação de Seguro/estatística & dados numéricos , Infarto do Miocárdio/terapia , Revascularização Miocárdica/métodos , Programas Nacionais de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/economia , Infarto do Miocárdio/mortalidade , Revascularização Miocárdica/economia , Programas Nacionais de Saúde/economia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos , Taxa de Sobrevida/tendências , Adulto Jovem
18.
Circ Cardiovasc Qual Outcomes ; 7(6): 882-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25387777

RESUMO

BACKGROUND: It is unknown whether hospitals with percutaneous coronary intervention (PCI) capability provide costlier care than hospitals without PCI capability for patients with acute myocardial infarction. The growing number of PCI hospitals and higher rate of PCI use may result in higher costs for episodes-of-care initiated at PCI hospitals. However, higher rates of transfers and postacute care procedures may result in higher costs for episodes-of-care initiated at non-PCI hospitals. METHODS AND RESULTS: We identified all 2008 acute myocardial infarction admissions among Medicare fee-for-service beneficiaries by principal discharge diagnosis and classified hospitals as PCI- or non-PCI-capable on the basis of hospitals' 2007 PCI performance. We added all payments from admission through 30 days postadmission, including payments to hospitals other than the admitting hospital. We calculated and compared risk-standardized payment for PCI and non-PCI hospitals using 2-level hierarchical generalized linear models, adjusting for patient demographics and clinical characteristics. PCI hospitals had a higher mean 30-day risk-standardized payment than non-PCI hospitals (PCI, $20 340; non-PCI, $19 713; P<0.001). Patients presenting to PCI hospitals had higher PCI rates (39.2% versus 13.2%; P<0.001) and higher coronary artery bypass graft rates (9.5% versus 4.4%; P<0.001) during index admissions, lower transfer rates (2.2% versus 25.4%; P<0.001), and lower revascularization rates within 30 days (0.15% versus 0.27%; P<0.0001) than those presenting to non-PCI hospitals. CONCLUSIONS: Despite higher PCI and coronary artery bypass graft rates for Medicare patients initially presenting to PCI hospitals, PCI hospitals were only $627 costlier than non-PCI hospitals for the treatment of patients with acute myocardial infarction in 2008.


Assuntos
Planos de Pagamento por Serviço Prestado/economia , Gastos em Saúde , Hospitais , Medicare/economia , Infarto do Miocárdio/cirurgia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Infarto do Miocárdio/economia , Revascularização Miocárdica/economia , Estudos Retrospectivos , Estados Unidos
20.
Int J Cardiol ; 176(3): 724-30, 2014 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-25183535

RESUMO

BACKGROUND: Several studies have reported gender and socioeconomic differences in the use of revascularization procedures in patients with acute myocardial infarction. However, it is not clear whether these differences influence patients' survival. Moreover, most of the studies neither considered STEMI and NSTEMI separately, nor included primary PCI, which nowadays is the treatment of choice in case of AMI. In an unselected population of patients admitted to hospital with a first episode of STEMI and NSTEMI we examined gender and socioeconomic differences in the use of cardiac invasive procedures and in one-year mortality. METHODS: Subjects hospitalized with a first episode of STEMI (n=3506) or NSTEMI (n=2286) were selected from the Piedmont (Italy) hospital discharge database. We considered the percentage of patients undergoing PCI, primary PCI and CABG, and in-hospital mortality. Out of hospital mortality was calculated through record linkage with the regional register. The relation between outcomes and gender or educational level was investigated using appropriate multivariate regression models adjusting for available confounders. RESULTS: After adjustment for age, comorbidity and hospital characteristics, women and low educated patients had a lower probability of undergoing revascularization procedures. However, neither in-hospital, nor 30-day, nor 1-year mortality showed gender or social disparities. CONCLUSIONS: Despite gender and socioeconomic differences in the use of revascularization, no differences emerged in in-hospital and 1-year mortality. These findings could suggest that patients are differently, but equitably, treated; differences are more likely due to an inability to fully adjust for clinical conditions rather than to a selection process at admission.


Assuntos
Disparidades em Assistência à Saúde , Mortalidade Hospitalar/tendências , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/mortalidade , Intervenção Coronária Percutânea/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Infarto do Miocárdio/economia , Revascularização Miocárdica/economia , Revascularização Miocárdica/métodos , Revascularização Miocárdica/mortalidade , Intervenção Coronária Percutânea/economia , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA