title: Cost estimates for treatment of cardiac ischemia (from the Asymptomatic Cardiac Ischemia Pilot [ACIP] study).
abstract: Costs for management of myocardial ischemia are enormous, yet comparison cost and outcome data for various ischemia treatment strategies from randomized trials are lacking and will require cost and resource utilization data from a large prospective trial. The Asymptomatic Cardiac Ischemia Pilot provided feasibility data for planning such a trial and an opportunity to estimate the long-term costs of different treatment strategies. Economic implications for ischemia management were compared in 558 patients with stable coronary artery disease and myocardial ischemia during both stress testing and daily life. Participants were randomized to 3 different initial treatment strategies and followed for 2 years. Based on cost trends over follow-up, costs for subsequent care were estimated. As expected, due to initial procedural costs, at 3 months, estimated costs for revascularization were approximately 10 times greater than costs for a medical care strategy. Extrapolated costs for anticipated resource consumption for care beyond 2 years, however, were approximately 2 times greater for an initial medical care strategy than for initial revascularization. This was due to increased need for drugs and hospitalizations for both late revascularizations and other ischemia-related events. Estimated costs for anticipated care in the medical strategies reached the anticipated cost of the revascularization strategy within 10 years. Because this cost-equal time period is well within the median life expectancy for such a patient population, these findings could have important public health implications and require testing in a full-scale prognosis trial. We anticipate that over the patients' life expectancy, early revascularization is likely to become either cost-neutral or cost-effective.
authors.affiliation: University of Florida College of Medicine, Division of Cardiovascular Medicine, Gainesville, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: D B
authors.initials: DB
authors.lastname: Mark
authors.forename: M G
authors.initials: MG
authors.lastname: Bourassa
authors.forename: B R
authors.initials: BR
authors.lastname: Chaitman
authors.forename: R F
authors.initials: RF
authors.lastname: Davies
authors.forename: G L
authors.initials: GL
authors.lastname: Knatterud
authors.forename: S
authors.initials: S
authors.lastname: Forman
authors.forename: C M
authors.initials: CM
authors.lastname: Pratt
authors.forename: G
authors.initials: G
authors.lastname: Sopko
authors.forename: C R
authors.initials: CR
authors.lastname: Conti
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D001026:Coronary Artery Bypass / Q000191:economics; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000191:economics* / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization / Q000191:economics* / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome