Published Online
on June 28, 2004

A more recent version of this article appeared on July 20, 2004

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Submitted on March 31, 2003
Revised on March 25, 2004
Accepted on March 29, 2004

Clinical and Economic Outcomes of Percutaneous Coronary Interventions in the Elderly. An Analysis of Medicare Claims Data

Mary Ann Clark MHA, Ameet Bakhai MD, MRCP, Michael J. Lacey MS, Elise M. Pelletier MS, and David J. Cohen MD, MSc^*

From the Department of Health Economics and Outcomes Research, Boston Scientific Corporation, Natick, Mass (M.A.C., M.L., E.M.P.); Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.B., D.J.C.); Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London, UK (A.B.); and Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (D.J.C.).

^* To whom correspondence should be addressed. E-mail: dcohen{at}caregroup.harvard.edu.

Background--Outcomes after percutaneous coronary intervention (PCI) have been documented extensively in clinical trials and single-center series, but few data exist on the clinical and economic outcomes after PCI in an unselected population.

Methods and Results--We used the Medicare Standard Analytic File to identify all initial PCI procedures performed in 1998 among a random sample of 5% of all Medicare beneficiaries 65 years of age. These patients (n=9868) were followed up for 1 year after PCI to identify clinical outcomes, medical resource use, and costs. Between 1 month and 1 year after PCI, 16.9% of patients required 1 repeat revascularization procedures. Mean 1-year medical care costs increased 5-fold among patients with repeat revascularization compared with those without ($26 186 versus $5344; P<0.001). After adjustment for baseline differences, the independent cost of repeat revascularization was $19 074 (95% CI, 18 440 to 19 707). Assuming from previous studies that 85% of repeat revascularization procedures over the first year of follow-up are attributable to restenosis, the estimated clinical restenosis rate was 14.4%, and the 1-year economic burden of restenosis to the healthcare system was $2747 per initial PCI procedure.

Conclusions--Among unselected elderly patients undergoing PCI, repeat revascularization occurs in 14% and increases 1-year healthcare costs by >$19 000 per occurrence. These findings have important implications for the cost-effectiveness of new treatments that substantially reduce restenosis.

Key words: angioplasty • cost-benefit analysis • epidemiology • restenosis • stents

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