Abstract 2988: Changes in Coronary Revascularization Treatment Patterns Among Diabetic Patients: Results from the U.S. Medicare Program
Background: Recent studies have shown that the introduction of drug-eluting stents (DES) has led to increasing use of PCI and declining use of CABG as the primary mode of coronary revascularization. Diabetic patients may be uniquely affected by these changes in revascularization patterns since studies have suggested a benefit of CABG over PCI in these patients.
Methods: We used the Medicare 5% Standard Analytic Files to examine the selection of revascularization procedures, clinical outcomes, and costs in the year following PCI or CABG among unselected diabetic patients, aged ≤ 65 treated in 2001 (pre-DES) and 2004 (post-DES). Costs were assessed from the Medicare program perspective in 2006 dollars.
Results: From 2001 to 2004, the revascularization rate among diabetic Medicare beneficiaries remained stable, while the proportion treated with initial PCI increased (65.2% to 73.7%, p<0.001). Over a median follow-up period of 13.5 months, there was no significant difference in mortality while the incidence of MI decreased (see Table⇓). After excluding repeat procedures during the index quarter, the incidence of any repeat revascularization decreased by 1.8% as well (p<0.001). Cardiovascular (CV)-related costs decreased by $1857 (p<0.001) per patient, with ~50% of the reduction occurring in the index hospitalization ($939, p<0.001). Overall medical care costs decreased more modestly due to a parallel increase in non-CV related costs.
Conclusion: Among diabetic Medicare beneficiaries, the introduction of DES was associated with a substantial shift in the proportion of patients treated with PCI vs. CABG as an initial revascularization strategy. These changes were associated with improved clinical outcomes and lower total CV-related costs per revascularization patient at ~1 yr.