The clinical and cost burden of coronary calcification in a Medicare cohort

An economic model to address under-reporting and misclassification

Louis P. Garrison, Jack Lewin, Christopher H. Young, Philippe Genereux, Janna Crittendon, Marita R. Mann, Ralph G. Brindis

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Coronary artery calcification (CAC) is a well-established risk factor for the occurrence of adverse ischemic events. However, the economic impact of the presence of CAC is unknown. Objectives: Through an economic model analysis, we sought to estimate the incremental impact of CAC on medical care costs and patient mortality for de novo percutaneous coronary intervention (PCI) patients in the 2012 cohort of the Medicare elderly (≥. 65) population. Methods: This aggregate burden-of-illness study is incidence-based, focusing on cost and survival outcomes for an annual Medicare cohort based on the recently introduced ICD9 code for CAC. The cost analysis uses a one-year horizon, and the survival analysis considers lost life years and their economic value. Results: For calendar year 2012, an estimated 200,945 index (de novo) PCI procedures were performed in this cohort. An estimated 16,000 Medicare beneficiaries (7.9%) were projected to have had severe CAC, generating an additional cost in the first year following their PCI of $3500, on average, or $56 million in total. In terms of mortality, the model projects that an additional 397 deaths would be attributable to severe CAC in 2012, resulting in 3770 lost life years, representing an estimated loss of about $377 million, when valuing lost life years at $100,000 each. Conclusions: These model-based CAC estimates, considering both moderate and severe CAC patients, suggest an annual burden of illness approaching $1.3 billion in this PCI cohort. The potential clinical and cost consequences of CAC warrant additional clinical and economic attention not only on PCI strategies for particular patients but also on reporting and coding to achieve better evidence-based decision-making.

Original languageEnglish (US)
Pages (from-to)406-412
Number of pages7
JournalCardiovascular Revascularization Medicine
Volume16
Issue number7
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

Fingerprint

Economic Models
Medicare
Coronary Vessels
Costs and Cost Analysis
Percutaneous Coronary Intervention
Cost of Illness
Economics
Mortality
Survival Analysis
Health Care Costs
Decision Making
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Garrison, Louis P. ; Lewin, Jack ; Young, Christopher H. ; Genereux, Philippe ; Crittendon, Janna ; Mann, Marita R. ; Brindis, Ralph G. / The clinical and cost burden of coronary calcification in a Medicare cohort : An economic model to address under-reporting and misclassification. In: Cardiovascular Revascularization Medicine. 2015 ; Vol. 16, No. 7. pp. 406-412.
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The clinical and cost burden of coronary calcification in a Medicare cohort : An economic model to address under-reporting and misclassification. / Garrison, Louis P.; Lewin, Jack; Young, Christopher H.; Genereux, Philippe; Crittendon, Janna; Mann, Marita R.; Brindis, Ralph G.

In: Cardiovascular Revascularization Medicine, Vol. 16, No. 7, 01.10.2015, p. 406-412.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The clinical and cost burden of coronary calcification in a Medicare cohort

T2 - An economic model to address under-reporting and misclassification

AU - Garrison, Louis P.

AU - Lewin, Jack

AU - Young, Christopher H.

AU - Genereux, Philippe

AU - Crittendon, Janna

AU - Mann, Marita R.

AU - Brindis, Ralph G.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background: Coronary artery calcification (CAC) is a well-established risk factor for the occurrence of adverse ischemic events. However, the economic impact of the presence of CAC is unknown. Objectives: Through an economic model analysis, we sought to estimate the incremental impact of CAC on medical care costs and patient mortality for de novo percutaneous coronary intervention (PCI) patients in the 2012 cohort of the Medicare elderly (≥. 65) population. Methods: This aggregate burden-of-illness study is incidence-based, focusing on cost and survival outcomes for an annual Medicare cohort based on the recently introduced ICD9 code for CAC. The cost analysis uses a one-year horizon, and the survival analysis considers lost life years and their economic value. Results: For calendar year 2012, an estimated 200,945 index (de novo) PCI procedures were performed in this cohort. An estimated 16,000 Medicare beneficiaries (7.9%) were projected to have had severe CAC, generating an additional cost in the first year following their PCI of $3500, on average, or $56 million in total. In terms of mortality, the model projects that an additional 397 deaths would be attributable to severe CAC in 2012, resulting in 3770 lost life years, representing an estimated loss of about $377 million, when valuing lost life years at $100,000 each. Conclusions: These model-based CAC estimates, considering both moderate and severe CAC patients, suggest an annual burden of illness approaching $1.3 billion in this PCI cohort. The potential clinical and cost consequences of CAC warrant additional clinical and economic attention not only on PCI strategies for particular patients but also on reporting and coding to achieve better evidence-based decision-making.

AB - Background: Coronary artery calcification (CAC) is a well-established risk factor for the occurrence of adverse ischemic events. However, the economic impact of the presence of CAC is unknown. Objectives: Through an economic model analysis, we sought to estimate the incremental impact of CAC on medical care costs and patient mortality for de novo percutaneous coronary intervention (PCI) patients in the 2012 cohort of the Medicare elderly (≥. 65) population. Methods: This aggregate burden-of-illness study is incidence-based, focusing on cost and survival outcomes for an annual Medicare cohort based on the recently introduced ICD9 code for CAC. The cost analysis uses a one-year horizon, and the survival analysis considers lost life years and their economic value. Results: For calendar year 2012, an estimated 200,945 index (de novo) PCI procedures were performed in this cohort. An estimated 16,000 Medicare beneficiaries (7.9%) were projected to have had severe CAC, generating an additional cost in the first year following their PCI of $3500, on average, or $56 million in total. In terms of mortality, the model projects that an additional 397 deaths would be attributable to severe CAC in 2012, resulting in 3770 lost life years, representing an estimated loss of about $377 million, when valuing lost life years at $100,000 each. Conclusions: These model-based CAC estimates, considering both moderate and severe CAC patients, suggest an annual burden of illness approaching $1.3 billion in this PCI cohort. The potential clinical and cost consequences of CAC warrant additional clinical and economic attention not only on PCI strategies for particular patients but also on reporting and coding to achieve better evidence-based decision-making.

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