Document Detail


Clinical and economic outcomes after introduction of drug-eluting stents.
MedLine Citation:
PMID:  20712391     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In clinical trials, drug-eluting stents (DES) improve clinical outcomes but are more expensive than bare-metal stents (BMS).
OBJECTIVE: To assess clinical and economic outcomes of all percutaneous coronary intervention (PCI) procedures in a general interventional cardiology practice before and after DES introduction in 2003.
METHODS: We identified all patients undergoing PCI in 2000-2002 (early cohort, pre-DES era) and from 2004 through April 31, 2006 (late cohort, DES era) in a large PCI registry. Logistic and Cox proportional hazard models estimated the risk of adverse events; generalized linear modeling predicted economic outcomes.
RESULTS: We compared 4303 early-cohort patients with 3422 late-cohort patients. Most early-cohort patients (90%) had BMS implanted; the rest had atherectomy or balloon angioplasty only. Among late-cohort patients, 83% had DES, 14% BMS, and 6% balloon angioplasty or atherectomy only. In-hospital adverse-event rates and incidence of death or myocardial infarction (during a median follow-up of 22 months) were similar. Follow-up procedures were significantly fewer in the later era (hazard ratio for target lesion revascularization: 0.58; 95% confidence interval [CI], 0.50-0.68). Although catheterization lab supply costs were higher in the DES era, length of stay following index PCI and overall practice costs were reduced, on average, 0.40 days and $2053 in the late cohort (95% bootstrapped CI of adjusted mean difference, -$2937 to -$1197). Follow-up cardiac hospitalization costs were similar at 1 year.
CONCLUSIONS: Patients undergoing PCI following DES introduction experienced improved clinical outcomes during follow-up and reduced overall procedural costs, despite higher stent acquisition costs.
Authors:
Charanjit S Rihal; James L Ryan; Mandeep Singh; Ryan J Lennon; John F Bresnahan; Juliette T Liesinger; Bernard J Gersh; Henry H Ting; David R Holmes; Kirsten Hall Long
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of managed care     Volume:  16     ISSN:  1936-2692     ISO Abbreviation:  Am J Manag Care     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-17     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9613960     Medline TA:  Am J Manag Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  580-7     Citation Subset:  H    
Affiliation:
Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. rihal@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Coronary / economics*,  statistics & numerical data
Cohort Studies
Confidence Intervals
Coronary Restenosis / drug therapy*,  mortality,  therapy
Drug-Eluting Stents / economics*,  statistics & numerical data
Female
Health Care Costs
Humans
Kaplan-Meier Estimate
Length of Stay
Logistic Models
Male
Models, Economic
Proportional Hazards Models
Registries
Retrospective Studies
Risk Factors
Treatment Outcome
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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