title: The clinical and cost burden of coronary calcification in a Medicare cohort: An economic model to address under-reporting and misclassification.
abstract: BACKGROUND
  Coronary artery calcification (CAC) is a well-established risk factor for the occurrence of adverse ischemic events. However, the economic impact of the presence of CAC is unknown.
  
  
  OBJECTIVE
  Through an economic model analysis, we sought to estimate 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.
  
  
  METHODS
  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 cost analysis uses a one-year horizon, and the survival analysis considers lost life years and their economic value.
  
  
  RESULTS
  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 $3500, on average, or $56 million in total. In terms of mortality, the model projects that an additional 397 deaths would be attributable to severe CAC in 2012, resulting in 3770 lost life years, representing an estimated loss of about $377 million, when valuing lost life years at $100,000 each.
  
  
  CONCLUSIONS
  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 particular patients but also on reporting and coding to achieve better evidence-based decision-making.
authors.affiliation: University of Washington and VeriTech Corporation, Seattle, WA. Electronic address: lgarrisn@uw.edu.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
authors.affiliation: Cardiovascular Research Foundation, New York, NY.
authors.forename: Jack
authors.initials: J
authors.lastname: Lewin
authors.affiliation: The Moran Company, Washington, D.C.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Young
authors.affiliation: Cardiovascular Research Foundation, New York, NY; Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: JC Consulting Group, Inc., Boston, MA.
authors.forename: Janna
authors.initials: J
authors.lastname: Crittendon
authors.affiliation: University of Washington and VeriTech Corporation, Seattle, WA.
authors.forename: Marita R
authors.initials: MR
authors.lastname: Mann
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Brindis
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000145:classification / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D003951:Diagnostic Errors / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases / Q000191:economics*; D008297:Male; D006278:Medicare / Q000191:economics*; D018803:Models, Economic; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000145:classification / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*
keywords: Calcification; Coronary; Economics; Medicare