Cost of care for new-onset acute coronary syndrome patients who undergo coronary revascularization.
OBJECTIVE
This study examines demographic, health characteristics, and total health care utilization in acute coronary syndrome (ACS) patients who underwent coronary revascularization within the first year of follow-up.


BACKGROUND
Revascularization during or after the index ACS event is becoming more common, and it is important to further characterize these patients.


METHODS
A retrospective claims analysis was conducted (July 1, 1999-June 30, 2001) with new onset ACS patients, defined as an emergency room visit or hospitalization with an ICD-9 code for unstable angina (UA) or acute myocardial infarction (AMI), but without an ACS claim in the previous 6 months. Patients were followed up to 12 months to identify total resource utilization (medical, pharmacy, revascularization procedures).


RESULTS
A total of 6,929 patients were included and 69% had revascularization performed during the index hospitalization. Mean age was 55 years; 72.9% were male. Revascularization was percutaneous coronary intervention (PCI) in 5,002 and bypass surgery in 1,927. The index ACS event was AMI in 48.9%; 13.5% had both AMI and UA. Total first-year cost was 210.7 million dollars (30,402 dollars per patient); hospitalization costs were 161.7 million dollars (23,331 dollars per patient). During follow-up, 75.5% received a statin, 75.8% a beta-blocker, and 63.5% of all patients received clopidogrel (84.8% of PCI patients). Mean days of clopidogrel therapy were 83.5.


CONCLUSIONS
Early revascularization is a frequent therapeutic strategy in these relatively young managed care patients. The majority of costs were medical and a majority of procedures were PCI. Many patients experienced AMI as their initial cardiovascular event. Drug utilization of statins, beta-blockers, and clopidogrel, according to practice guidelines, was acceptable.
McCollam
Patrick
P
Global Health Outcomes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. mccollam_patrick_1@lilly.com
Etemad
Lida
L
D000208:Acute Disease; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000191:economics* / Q000601:surgery*; D000077144:Clopidogrel; D005260:Female; D017048:Health Care Costs; D006301:Health Services Needs and Demand; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000191:economics* / Q000601:surgery*; D009204:Myocardial Revascularization / Q000191:economics* / Q000379:methods; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D014481:United States
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine