Resource use trajectories for aged medicare beneficiaries with complex coronary conditions.
OBJECTIVE
To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use.


METHODS
Medicare inpatient and outpatient claims from 2002 to 2008 for patients receiving multivessel revascularization for symptomatic coronary disease in 2003-2004.


METHODS
This retrospective cohort study of 102,877 beneficiaries assessed survival, days in institutional settings, and Medicare payments for up to 6 years following receipt of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).


METHODS
A three-part estimator designed to provide robust estimates of a treatment's effect in the setting of mortality and censored follow-up was used. The estimator decomposes the treatment effect into effects attributable to survival differences versus treatment-related intensity of resource use.


RESULTS
After adjustment, on average CABG recipients survived 23 days longer, spent an 11 additional days in institutional settings, and had cumulative Medicare payments that were $12,834 higher than PCI recipients. The majority of the differences in institutional days and payments were due to intensity rather than survival effects.


CONCLUSIONS
In this example, the survival benefit from CABG was modest and the resource implications were substantial, although further adjustments for treatment selection are needed.
Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA.
Jerome J
JJ
Federspiel
Sally C
SC
Stearns
Laura P
LP
D'Arcy
Kimberley H
KH
Geissler
Christopher A
CA
Beadles
Daniel J
DJ
Crespin
Timothy S
TS
Carey
Joseph S
JS
Rossi
Brett C
BC
Sheridan
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D006328:Cardiac Catheterization / Q000191:economics; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000191:economics; D003324:Coronary Artery Disease / Q000191:economics* / Q000401:mortality; D003365:Costs and Cost Analysis; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics*; D010045:Outpatients / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States