| Clinical correlates of the initial and long-term cost of coronary bypass surgery and coronary angioplasty. | |
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MedLine Citation:
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PMID: 10426855 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Medical costs vary substantially among patients. Understanding the baseline factors that predict subsequent cost may allow better selection of therapy for individual patients. Understanding the postprocedure events that increase cost should help to improve efficiency and effectiveness of coronary revascularization. METHODS: Data on 4-year costs were collected from patients randomly assigned to coronary angioplasty or bypass surgery as part of the BARI (Bypass Angioplasty Revascularization Investigation) trial. Regression models first examined factors known at the time of randomization that prospectively predicted initial procedure cost and long-term cost. Subsequent models tested the value of postrandomization events as explanatory variables for cost. RESULTS: The independent baseline predictors of higher initial percutaneous transluminal coronary angioplasty cost included 3-vessel disease (+12%) and acute presentations (+22%), whereas the independent predictors of higher initial coronary artery bypass grafting cost included the number of comorbid conditions (+5% per condition) and female sex (+7%). The independent baseline predictors of 4-year cost included heart failure (+26%), diabetes (+22%), comorbidity (+10%), and angioplasty assignment in patients with 2-vessel disease (-15%). Postrandomization models showed higher initial and long-term costs were strongly correlated with the number of repeat revascularization procedures (+30% to +128%) and the occurrence of clinical complications (+8% to +131%). CONCLUSIONS: Two-vessel disease identifies patients likely to have lower costs after angioplasty, whereas heart failure, comorbid conditions, and diabetes identify patients likely to accrue higher costs after either angioplasty or bypass surgery. Long-term costs can be potentially reduced by interventions that decrease procedural complications or reduce the need for repeat revascularization. |
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Authors:
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M A Hlatky; D B Boothroyd; M M Brooks; C Winston; A Rosen; W J Rogers; G S Reeder; H C Smith; T J Ryan; B Pitt; P L Whitlow; R D Wiens; D B Mark |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: American heart journal Volume: 138 ISSN: 0002-8703 ISO Abbreviation: Am. Heart J. Publication Date: 1999 Aug |
Date Detail:
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Created Date: 1999-08-26 Completed Date: 1999-08-26 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 376-83 Citation Subset: AIM; IM |
Affiliation:
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Department of Health Research and Policy, Stanford University School of Medicine, HRP Redwood Bldg, Room 150, Stanford, 94305-5405, USA. hlatky@stanford.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary / economics* Coronary Artery Bypass / economics* Coronary Disease / economics, surgery, therapy* Episode of Care Female Health Care Costs / statistics & numerical data* Health Services Research / economics Humans Male Medicare Middle Aged United States |
| Grant Support | |
ID/Acronym/Agency:
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HL38610/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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