Author + information
- Louis P. Garrison1,
- Jack Lewin2,
- Christopher H. Young3,
- Philippe Généreux2,
- Janna Crittendon4,
- Marita R. Mann1 and
- Ralph G. Brindis5
Coronary artery calcification (CAC) is an established risk factor for poor cardiovascular clinical outcomes. This economic modeling analysis estimates the incremental impact of CAC on medical care costs and patient mortality for de novo percutaneous coronary intervention (PCI) patients in the 2012 cohort of the Medicare elderly (>65) population.
The target study population is the Medicare elderly with atherosclerosis in calendar year 2012 experiencing a new index event, defined as a patient receiving a coronary angiogram with no prior coronary revascularization in the preceding six months. This aggregate burden of illness study is incidence-based, focusing on cost and survival outcomes for an annual Medicare cohort based on the recently introduced ICD9 code for CAC. The horizon of the cost analysis uses a one-year horizon, and the survival analysis considers lost life years and their economic value. The principal data sources for cost and survival analyses were Medicare’s Standard Analytic Files. Estimates of the degree of calcification and the incidence of MACE were based on the HORIZONS-AMI/ACUITY elderly pooled sample.
For calendar year 2012, an estimated 200,945 index (de novo) PCI procedures were performed in this cohort. An estimated 16,000 Medicare beneficiaries (7.9%) were projected to have had severe CAC generating an additional cost in the first year following their PCI of $3,500, on average, or $56 million in total. In terms of mortality, the model projects an additional 397 deaths would be attributable to severe CAC in 2012, resulting in 3,770 lost life years, representing an estimated loss of about $377 million, when valuing lost life years at $100,000 each. An estimated 63,000 patients had moderate CAC.
These model-based CAC estimates, considering both moderate and severe CAC patients, suggest an annual burden of illness approaching $1.3 billion in this PCI cohort. The potential clinical and cost consequences of CAC warrant additional clinical and economic attention not only on PCI strategies for appropriate patients but also on reporting and coding to achieve better evidence-based decision making.