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- Title
Resource use trajectories for aged medicare beneficiaries with complex coronary conditions.
- Authors
Federspiel, Jerome J; Stearns, Sally C; D'Arcy, Laura P; Geissler, Kimberley H; Beadles, Christopher A; Crespin, Daniel J; Carey, Timothy S; Rossi, Joseph S; Sheridan, Brett C
- Abstract
<bold>Objective: </bold>To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use.<bold>Data Sources: </bold>Medicare inpatient and outpatient claims from 2002 to 2008 for patients receiving multivessel revascularization for symptomatic coronary disease in 2003-2004.<bold>Study Design: </bold>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).<bold>Methods: </bold>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.<bold>Principal Findings: </bold>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.<bold>Conclusions: </bold>In this example, the survival benefit from CABG was modest and the resource implications were substantial, although further adjustments for treatment selection are needed.
- Publication
Health Services Research, 2013, Vol 48, Issue 2pt1, p753
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.12028