Hospitalization Costs for Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention in the United States Are Substantially Higher Than Medicare Payments

Afana, Majed; Brinjikji, Waleed; Cloft, Harry J.; Salka, Samer

doi:10.1002/clc.22341

Cited by 39 publications

(24 citation statements)

References 21 publications

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“…found that 45.9% were aged 65 and older. 34 These rates are not much higher than the rate estimated for trial participants in the current study. Conversely, the divergence from population data becomes much more prominent at the 75-year threshold.…”

Section: Discussioncontrasting

confidence: 53%

Exclusion of Elderly People from Randomized Clinical Trials of Drugs for Ischemic Heart Disease

Bourgeois

Orenstein

Ballakur

et al. 2017

J American Geriatrics Society

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Background/Objectives Evidence-based and patient-centered care of elderly adults with ischemic heart disease requires clinical trials that study the patient population seen by clinicians in practice. We aimed to measure the exclusion of elderly persons from randomized trials studying drug interventions for ischemic heart disease and describe the characteristics of these trials. Design and setting Interventional clinical trials studying a drug intervention for ischemic heart disease and started 2006 and after were identified in ClinicalTrials.gov. Data were extracted on study features, including age-based inclusion criteria. Data on participants and their age distribution were collected from trial publications, investigator inquiry, and result data in ClinicalTrials.gov. Measurements Proportion of trials excluding patients based on age, mean age of trial participants, and proportion of enrolled participants who were ≥65 years and ≥75 years. Results Of 839 identified trials, 446 (53%) explicitly excluded elderly persons. The most frequent upper age limits were 80 (n=164) and 75 (n=114) with a median upper age limit of 80 (IQR 75, 80). Trials with upper age limit exclusions tended to be smaller (median number of participants 100 vs 201, p<0.001) and were more likely to be funded primarily by non-industry sources (78.3% vs 70.0%, p=0.006). The overall mean age of trial participants was 62.7 years with a mean maximum age of 74 years. The estimated proportion of participants that was ≥65 years was 42.5% and the estimated proportion that was ≥75 years was 12.3%. Conclusion Despite the high burden of ischemic heart disease among elderly patients, the majority of drug trials do not enroll participants reflective of age-related prevalence of the disease.

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Section: Discussioncontrasting

confidence: 53%

Exclusion of Elderly People from Randomized Clinical Trials of Drugs for Ischemic Heart Disease

Bourgeois

Orenstein

Ballakur

et al. 2017

J American Geriatrics Society

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show abstract

Section: Discussionsupporting

confidence: 53%

“…It has been recently reported that the cost of patients with MI treated with percutaneous coronary intervention had stabilized but were still higher than Medicare reimbursements. 34 The data presented herein further document that comorbid conditions in general, and AF in particular, can be a substantial driver of incremental cost. Our finding that inpatient cost was the largest component of total cost was not surprising, because every patient in the study had ≥1 hospitalization during follow-up, and prior studies that assessed cost burden of AF in general have also found inpatient cost to be the largest component of total cost.…”

Section: Discussionsupporting

confidence: 52%

Association Between Atrial Fibrillation and Costs After Myocardial Infarction: A Community Study

Borah

Roger

Mills

et al. 2015

Clinical Cardiology

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Objective To estimate incremental economic impact of atrial fibrillation (AF) and the timing of its onset in myocardial infarction (MI) patients. Patients and Methods This retrospective cohort study included incident MI patients from Olmsted County, Minnesota, treated between 11/1/2002 and 12/31/2010. We compared inflation-adjusted standardized costs accumulated between incident MI and end of follow-up among 3 groups by AF status and its timing: no AF, new-onset AF (within 30 days after index MI), or prior AF. Multivariate adjustment of median costs accounted for right-censoring in costs. Results The final study cohort had 1,389 patients with 989 in no AF, 163 in new-onset AF, and 237 in prior AF categories. Median follow-up times were 3.98, 3.23, and 2.55 years, respectively. Mean age at index was 67 years, with significantly younger patients in no-AF group (64 years vs 76 and 77 years, respectively; P<.001). New-onset and prior AF patients had more comorbid conditions (hypertension, heart failure, and chronic obstructive pulmonary disease). After accounting for differences in baseline characteristics, we found adjusted median (95% CI) costs of $73,000 ($69,000–$76,000) for no AF; $85,000 ($81,000–$89,000) for new-onset AF; and $97,000 ($94,000–$100,000) for prior AF. Inpatient costs composed the largest share of total median costs (no AF, 82%; new-onset AF, 84%; and prior AF, 83%). Conclusion These findings indicate that AF frequently coexists with MI and imposes incremental costs, mainly attributable to inpatient care. AF timing matters as prior AF was found to be associated with higher costs than new-onset AF.

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“…While performing the cost analysis for patients hospitalised for percutaneous coronary intervention for acute myocardial infarction, the increase in costs over the course of period from 2004 to 2009 was recorded. Amongst the 265 531 patients who received the treatment, the costs increased from $15 889 ($12 057–$21 204) in 2001 to $19 349 ($14 660–$26 282) . Myocardial infarction and percutaneous coronary interventions were also reported to be one of the most expensive and frequent cardiovascular events, accounting for more than 75% of fatal cardiovascular events .…”

Section: Discussionmentioning

confidence: 99%

Cost analysis of management of cardiovascular disease comorbidities in Turkey

Kockaya

Oğuzhan

Özin

et al. 2019

J Pharm Health Serv Res

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Objectives The strongest muscle of human body, the heart, is susceptible to a range of diseases. These diseases involve deterioration of the blood vessels, muscles of heart, malformation of cardiovascular structures, tumour formations, formation of clots, rupturing of vessels and others. Therefore, taking into consideration the direct and indirect burdens of cardiovascular diseases around the globe, the present study was designed to perform a direct cost analysis of managing comorbidities of cardiovascular diseases with reimbursement authority perspective. Methods The cost analysis study conducted in the present article was conducted in three phases. The first phase involved filling of survey questionnaire by five experts practicing in the field of cardiology in Turkey. The second phase comprised of expert panel wherein three out of five experts reviewed the forms filled by all the experts. This was followed by third phase wherein the three experts attending the panel re‐filled the questionnaire as per the daily clinical practice. Key Findings The findings showed total annual costs for cardiovascular diseases (CVDs) exhibiting myocardial infarction comorbidities for both acute and maintenance treatment as 5622.95 and 1245.04 TL respectively. The total costs for major bleeding events were found to be 1211.95 TL, whereas for minor bleeding events the costs were 496.26 TL. The total cost for intracranial bleeding was 1761.53, and 3595.62 TL for stroke, which followed myocardial infarction. Conclusion The study findings helped gain an insight into the most prominent comorbidities associated with CVDs in the perspective of reimbursement institution including direct costs. Further studies are needed to understand the real cost for reimbursement institution.

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Hospitalization Costs for Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention in the United States Are Substantially Higher Than Medicare Payments

Cited by 39 publications

References 21 publications

Exclusion of Elderly People from Randomized Clinical Trials of Drugs for Ischemic Heart Disease

Exclusion of Elderly People from Randomized Clinical Trials of Drugs for Ischemic Heart Disease

Association Between Atrial Fibrillation and Costs After Myocardial Infarction: A Community Study

Cost analysis of management of cardiovascular disease comorbidities in Turkey

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