Document Detail


Resource use trajectories for aged medicare beneficiaries with complex coronary conditions.
MedLine Citation:
PMID:  23347002     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use.
DATA SOURCES: Medicare inpatient and outpatient claims from 2002 to 2008 for patients receiving multivessel revascularization for symptomatic coronary disease in 2003-2004.
STUDY DESIGN: This retrospective cohort study of 102,877 beneficiaries assessed survival, days in institutional settings, and Medicare payments for up to 6 years following receipt of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
METHODS: A three-part estimator designed to provide robust estimates of a treatment's effect in the setting of mortality and censored follow-up was used. The estimator decomposes the treatment effect into effects attributable to survival differences versus treatment-related intensity of resource use.
PRINCIPAL FINDINGS: After adjustment, on average CABG recipients survived 23 days longer, spent an 11 additional days in institutional settings, and had cumulative Medicare payments that were $12,834 higher than PCI recipients. The majority of the differences in institutional days and payments were due to intensity rather than survival effects.
CONCLUSIONS: In this example, the survival benefit from CABG was modest and the resource implications were substantial, although further adjustments for treatment selection are needed.
Authors:
Jerome J Federspiel; Sally C Stearns; Laura P D'Arcy; Kimberley H Geissler; Christopher A Beadles; Daniel J Crespin; Timothy S Carey; Joseph S Rossi; Brett C Sheridan
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.     Date:  2013-01-24
Journal Detail:
Title:  Health services research     Volume:  48     ISSN:  1475-6773     ISO Abbreviation:  Health Serv Res     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-13     Completed Date:  2013-05-09     Revised Date:  2014-10-10    
Medline Journal Info:
Nlm Unique ID:  0053006     Medline TA:  Health Serv Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  753-72     Citation Subset:  IM    
Copyright Information:
© Health Research and Educational Trust.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Ambulatory Care / economics*
Angioplasty, Balloon, Coronary / economics*
Cardiac Catheterization / economics
Cohort Studies
Coronary Artery Bypass / economics
Coronary Artery Disease / economics*,  mortality
Costs and Cost Analysis
Female
Health Expenditures / statistics & numerical data
Health Resources / economics*
Humans
Length of Stay / economics
Male
Medicare / economics*
Outpatients / statistics & numerical data
Retrospective Studies
Treatment Outcome
United States
Grant Support
ID/Acronym/Agency:
F30 HL110483/HL/NHLBI NIH HHS; F30-HL110483/HL/NHLBI NIH HHS; R01 AG025801/AG/NIA NIH HHS; R01-AG025801/AG/NIA NIH HHS; R36-HS021074/HS/AHRQ HHS; T32 AG000272/AG/NIA NIH HHS; T32 GM008719/GM/NIGMS NIH HHS; T32-AG000272/AG/NIA NIH HHS; T32-GM008719/GM/NIGMS NIH HHS; T32-HS000032/HS/AHRQ HHS
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