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, John C.; Young, Christopher; Généreux, Philippe; Crittendon, Janna; Mann, Marita; Brindis, Ralph G.

doi:10.1016/j.carrev.2015.08.002

Cited by 8 publications

(10 citation statements)

References 19 publications

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“…While a new ICD-9-CM diagnosis code (414.4) was introduced late in 2011 for severe CAC, actual documentation of CAC via administrative coding practice has lagged. For example, only 1.7% of patients with de novo PCIs were reported to have CAC, and the significant degree of underreporting of CAC in the Medicare population has recently been described [Garrison et al 2015]. This is the first published cost-effectiveness analysis that relies to any extent on the reporting and use of this ICD-9 code for de novo PCI patients in the elderly Medicare population.…”

Section: Costs Of Stent-implantation Proceduresmentioning

confidence: 99%

The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach

Chambers

Généreux

Lee

et al. 2015

Therapeutic Advances in Cardiovascular Disease

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Background:Patients who undergo percutaneous coronary intervention (PCI) for severely calcified coronary lesions have long been known to have worse clinical and economic outcomes than patients with no or mildly calcified lesions. We sought to assess the likely cost-effectiveness of using the Diamondback 360® Orbital Atherectomy System (OAS) in the treatment of de novo, severely calcified lesions from a health-system perspective.Methods and results:In the absence of a head-to-head trial and long-term follow up, cost-effectiveness was based on a modeled synthesis of clinical and economic data. A cost-effectiveness model was used to project the likely economic impact. To estimate the net cost impact, the cost of using the OAS technology in elderly (⩾ 65 years) Medicare patients with de novo severely calcified lesions was compared with cost offsets. Elderly OAS patients from the ORBIT II trial (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) [ClinicalTrials.gov identifier: NCT01092426] were indirectly compared with similar patients using observational data. For the index procedure, the comparison was with Medicare data, and for both revascularization and cardiac death in the following year, the comparison was with a pooled analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)/Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trials. After adjusting for differences in age, gender, and comorbidities, the ORBIT II mean index procedure costs were 17% (p < 0.001) lower, approximately US$2700. Estimated mean revascularization costs were lower by US$1240 in the base case. These cost offsets in the first year, on average, fully cover the cost of the device with an additional 1.2% cost savings. Even in the low-value scenario, the use of the OAS is cost-effective with a cost per life-year gained of US$11,895.Conclusions:Based on economic modeling, the recently approved coronary OAS device is projected to be highly cost-effective for patients who undergo PCI for severely calcified lesions.

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Section: Costs Of Stent-implantation Proceduresmentioning

confidence: 99%

The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach

Chambers

Généreux

Lee

et al. 2015

Therapeutic Advances in Cardiovascular Disease

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“…It is based on statewide data collection by individual data organizations across the USA and includes the largest collection of longitudinal hospital care data in the USA, encompassing all-payer, discharge-level information. The other AE and complication-related treatment cost data were obtained using the published literature [16][17][18][19]. These cost estimates were then inflated to 2016 (October) US dollars using the Medical Care Component of the Consumer Price Index [20].…”

Section: Cost End Pointsmentioning

confidence: 99%

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

et al. 2018

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Aim:The incremental cost of peripheral orbital atherectomy system (OAS) plus balloon angioplasty (BA) versus BA-only for critical limb ischemia was estimated. Materials & methods: A deterministic simulation model used clinical and healthcare utilization data from the CALCIUM 360• trial and current cost data. Incremental cost of OAS + BA versus BA-only included differential utilization during the procedure and adverse-event costs at 3, 6 and 12-months. Results: For every 100 procedures, incremental annual costs to the hospital were US$350,930 lower with OAS + BA compared with BA-only. Despite higher upfront costs, savings were realized due to reduced need for revascularization, amputation and end-of-life care over 6-12-month postoperative period. Conclusion: Atherectomy with OAS prior to BA was associated with cost savings to the hospital. Critical limb ischemia (CLI) is the most serious manifestation of peripheral artery disease (PAD). Considered as the 'end stage' of PAD, it involves a chronic lack of blood supply leading to persistent ischemic rest pain in the feet or toes, nonhealing wounds and ulcers, and gangrene [1]. CLI often results in amputation of the affected limb(s) with roughly 25% of CLI patients receiving at least one lower extremity amputation [2]. The economic burden of CLI-diagnosed Medicare patients exceeds US$3.1 billion annually, with most of this cost reflecting the high incidence of hospitalizations related to limb loss and the need for major amputation [3].Treating CLI patients has remained quite challenging, since the associated calcification requires a unique mechanism of action to treat the lesion without damaging the vessel [4]. Balloon angioplasty (BA) continues to be the first-line of revascularization strategy in patients where procedural success via less invasive, nonsurgical approach is favored despite consistently poor intermediate and long-term patency outcomes [5,6]. The latter has been attributed to the presence of calcified plaque in femoropopliteal lesions, with arterial wall calcium associated with higher rates of procedural complications, and flow-limiting dissections that frequently require stent deployment in order to maintain vessel patency [4][5][6]. Furthermore, restenosis rates as high as 40-60% within 1 year of postprocedure and poor correlation between primary patency and limb preservation have been reported. But the American College of Cardiology/American Heart Association guidelines currently recommend against primary stenting of femoropopliteal lesions with atherectomy and stent devices indicated for 'bailout' purposes following suboptimal BA results [5]. Stenting in calcified segments after a prior failed BA often results in stent under expansion and malapposition [6,7]. These are recognized predictors of long-term stent patency and indicate an increased risk of

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“…Coronary artery plaque calcification increases mortality 1.7-fold, whereas an extensive form increases it 60-fold [ 2 ]. It also increases economic burden in the form of cardiovascular disease [ 3 ]. Vascular calcification is an active process of depositing calcium in the form of hydroxyapatite in the vascular matrix [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Role of Glycosylation in Vascular Calcification

Masbuchin

Rohman

Liu

2021

IJMS

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Glycosylation is an important step in post-translational protein modification. Altered glycosylation results in an abnormality that causes diseases such as malignancy and cardiovascular diseases. Recent emerging evidence highlights the importance of glycosylation in vascular calcification. Two major types of glycosylation, N-glycosylation and O-glycosylation, are involved in vascular calcification. Other glycosylation mechanisms, which polymerize the glycosaminoglycan (GAG) chain onto protein, resulting in proteoglycan (PG), also have an impact on vascular calcification. This paper discusses the role of glycosylation in vascular calcification.

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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

Cited by 8 publications

References 19 publications

The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach

The potential cost-effectiveness of the Diamondback 360® Coronary Orbital Atherectomy System for treating de novo, severely calcified coronary lesions: an economic modeling approach

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

Role of Glycosylation in Vascular Calcification

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