Direct Medical Charges Associated With Myocardial Infarction in Patients With and Without Diabetes

Smith, Tammy; Melfi, Catherine A.; Kesterson, Joseph A.; Sandmann, Beverly J.; Kotsanos, James G.

doi:10.1097/00005650-199904001-00002

Cited by 18 publications

(8 citation statements)

References 8 publications

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“…The finding that inpatient costs represent a large proportion of the annual medical costs in patients with MVD is consistent with earlier studies. 12,13,19,33 These studies also suggest that much of the added cost of MVDs results from hospitalizations for heart attacks, heart failure, and other major cardiovascular events.…”

Section: Characteristics Of Patient Groupsmentioning

confidence: 98%

Total and Component Health Care Costs in a Non-Medicare HMO Population of Patients With and Without Type 2 Diabetes and With and Without Macrovascular Disease

Gandra¹,

Lawrence²,

Parasuraman³

et al. 2006

JMCP

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Section: Characteristics Of Patient Groupsmentioning

confidence: 98%

Total and Component Health Care Costs in a Non-Medicare HMO Population of Patients With and Without Type 2 Diabetes and With and Without Macrovascular Disease

Gandra¹,

Lawrence²,

Parasuraman³

et al. 2006

JMCP

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“…Furthermore, an analysis of several individual studies showed that atherosclerosis in Type II diabetes accounted for approximately one third of the total healthcare costs related to the disease [15]. In a study of patients with myocardial infarction (MI), patients with diabetes had a higher per-patient total direct medical charge (inclusive of initial hospitalisation) compared to patients without diabetes [16].…”

Section: :S 13-s 17]mentioning

confidence: 99%

Assessing the impact of complications on the costs of Type II diabetes

Williams

Gaal²,

Lucioni³

2002

Diabetologia

306

220

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Aimslhypothesis. 'The Cost of Diabetes in EuropeType II (CODE-2) study' provides the first coordinated attempt to assess the total costs of managing people with Type II (non-insulin-dependent) diabetes mellitus in Europe. Type II diabetes is associated with a number of serious long-term complications, which are a major cause of morbidity, hospitalisation and mortality in diabetic patients. Methods. Patients were divided into four broad categories defining their complication status in terms of no complications, one or more microvascular complications, one or more macrovascular complications or one or more of each microvascular and macrovascular complication. The prevalence of complications and associated costs were assessed retrospectively for 6 months.Results. In total, 72% of patients in the CODE-2 study had at least one complication, with 19% having microvascular only, 10% having macrovascular only and 24% of the total having both microvascular and macrovascular complications. Of patients with microvascular complications, 28% had neuropathy, 20% renal damage, 20% retinopathy and 6.5% required treatment far eye complications. Among the patients with macrovascular complications, 18% had periphera1 vascular disease, 17% angina, 12% heart failure and 9% had myocardia1 infarction. Percutaneous trans1uminal coronary angiop1asty, coronary artery bypass graft or stroke occurred in 3%, 4% and 5% of the patients, respective1y. In patients with both microvascu1ar and macrovascular complications, the total cost of management was increased by up to 250% compared to those without complications. Conclusionlinterpretation. Complications have a substantial impact on the costs of managing Type II diabetes. This study has confirmed that the prevention of diabetic complications will not only benefit patients, but potentially reduce overall healthcare expenditure. [Diabetologia (2002) 45:S 13-S 17]

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“…Cost estimates have been expressed as 2011 USD.aEmergency room visit cost of USD854 (816) was added to post-discharge incidences of MI, stroke and major bleeding 30, 53. Based on a length of stay of 3 days,36 one third of MI,19 stroke and major bleeding incidences during first 30 days were post-discharge.…”

Section: Methodsmentioning

confidence: 99%

Cost-utility analysis of genotype-guided antiplatelet therapy in patients with moderate-to-high risk acute coronary syndrome and planned percutaneous coronary intervention

Patel

Lin

Ojo

et al. 2014

Pharmacy Practice (Internet)

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BackgroundPrasugrel is recommended over clopidogrel in poor/intermediate CYP2C19 metabolizers with acute coronary syndrome (ACS) and planned percutaneous coronary intervention (PCI), reducing the risk of ischemic events. CYP2C19 genetic testing can guide antiplatelet therapy in ACS patients.ObjectiveThe purpose of this study was to evaluate the cost-utility of genotype-guided treatment, compared with prasugrel or generic clopidogrel treatment without genotyping, from the US healthcare provider’s perspective.MethodsA decision model was developed to project lifetime economic and humanistic burden associated with clinical outcomes (myocardial infarction [MI], stroke and major bleeding) for the three strategies in patients with ACS. Probabilities, costs and age-adjusted quality of life were identified through systematic literature review. Incremental cost-utility ratios (ICURs) were calculated for the treatment strategies, with quality-adjusted life years (QALYs) as the primary effectiveness outcome. Relative risk of developing myocardial infarction and stroke between patients with and without variant CYP2C19 when receiving clopidogrel were estimated to be 1.34 and 3.66, respectively. One-way and probabilistic sensitivity analyses were performed.ResultsClopidogrel cost USD19,147 and provided 10.03 QALYs versus prasugrel (USD21,425, 10.04 QALYs) and genotype-guided therapy (USD19,231, 10.05 QALYs). The ICUR of genotype-guided therapy compared with clopidogrel was USD4,200. Genotype-guided therapy provided more QALYs at lower costs compared with prasugrel. Results were sensitive to the cost of clopidogrel and relative risk of myocardial infarction and stroke between CYP2C19 variant vs. non-variant. Net monetary benefit curves showed that genotype-guided therapy had at least 70% likelihood of being the most cost-effective alternative at a willingness-to-pay of USD100,000/QALY. In comparison with clopidogrel, prasugrel therapy was more cost-effective with <21% certainty at willingness-to-pay of >USD170,000/QALY.ConclusionsOur modeling analyses suggest that genotype-guided therapy is a cost-effective strategy in patients with acute coronary syndrome undergoing planned percutaneous coronary intervention.

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Direct Medical Charges Associated With Myocardial Infarction in Patients With and Without Diabetes

Cited by 18 publications

References 8 publications

Total and Component Health Care Costs in a Non-Medicare HMO Population of Patients With and Without Type 2 Diabetes and With and Without Macrovascular Disease

Total and Component Health Care Costs in a Non-Medicare HMO Population of Patients With and Without Type 2 Diabetes and With and Without Macrovascular Disease

Assessing the impact of complications on the costs of Type II diabetes

Cost-utility analysis of genotype-guided antiplatelet therapy in patients with moderate-to-high risk acute coronary syndrome and planned percutaneous coronary intervention

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