Mary Ann Clark

Drug-eluting stent task force: Final report and recommendations of the working committees on cost-effectiveness/economics, access to care, and medicolegal issues

Coronary artery disease remains a major health problem worldwide. Since introduction of percutaneous transluminal coronary angioplasty and stents, much progress has been made. Percutaneous coronary intervention, however, has been limited by restenosis (repeat obstruction of arteries that have been previously treated. Introduction of drug‐eluting stents (DESs) in April 2003 was a major breakthrough in preventing restenosis. In March 2003, The Society for Cardiovascular Angiography and Interventions (SCAI) published a position statement on the clinical implications of DESs, recommending an evidence‐based adoption strategy. Subsequently, in May 2003, SCAI formed a multidisciplinary Drug Eluting Stent (DES) Task Force to address the significant nonclinical ramifications posed by DESs: medicolegal, financial, and access to care. The Task Force included representatives from physician societies, industry, academia, the reimbursement community, and health policy organizations. The resultant report presents analyses, options, and recommendations regarding those nonclinical issues based on the collective experience and knowledge of the Task Force members. The Task Force trusts that this report will be of value to the diverse constituencies involved with introduction of this important new technology. Catheter Cardiovasc Interv 2004;62: 1–17.

Clinical and Economic Outcomes of Percutaneous Coronary Interventions in the Elderly An Analysis of Medicare Claims Data

Background—Outcomes after percutaneous coronary intervention (PCI) have been documented extensively in clinical trials and single-center series, but few data exist on the clinical and economic outcomes after PCI in an unselected population. Methods and Results—We used the Medicare Standard Analytic File to identify all initial PCI procedures performed in 1998 among a random sample of 5% of all Medicare beneficiaries ≥65 years of age. These patients (n=9868) were followed up for 1 year after PCI to identify clinical outcomes, medical resource use, and costs. Between 1 month and 1 year after PCI, 16.9% of patients required ≥1 repeat revascularization procedures. Mean 1-year medical care costs increased 5-fold among patients with repeat revascularization compared with those without (

Rechargeable Spinal Cord Stimulation Versus Nonrechargeable System for Patients With Failed Back Surgery Syndrome: A Cost-Consequences Analysis

26 186 versus

Five-year clinical and economic outcomes among patients with medically managed severe aortic stenosis: results from a Medicare claims analysis.

5344; P <0.001). After adjustment for baseline differences, the independent cost of repeat revascularization was

Clinical and economic outcomes after surgical aortic valve replacement in Medicare patients

19 074 (95% CI, 18 440 to 19 707). Assuming from previous studies that 85% of repeat revascularization procedures over the first year of follow-up are attributable to restenosis, the estimated clinical restenosis rate was 14.4%, and the 1-year economic burden of restenosis to the healthcare system was

Medicare costs and health resource utilisation associated with atrial fibrillation in the elderly

2747 per initial PCI procedure. Conclusions—Among unselected elderly patients undergoing PCI, repeat revascularization occurs in ≈14% and increases 1-year healthcare costs by >

Changing treatment patterns for coronary artery revascularization in Canada: the projected impact of drug eluting stents

19 000 per occurrence. These findings have important implications for the cost-effectiveness of new treatments that substantially reduce restenosis.

FIVE-YEAR CLINICAL AND ECONOMIC OUTCOMES IN PATIENTS WITH MEDICALLY MANAGED SEVERE AORTIC STENOSIS: RESULTS FROM A MEDICARE CLAIMS ANALYSIS

ObjectivesSpinal cord stimulation (SCS) has been used for almost 40 years to treat refractory neuropathic pain after failed back surgery. Fully implantable nonrechargeable pulse generators have a battery life of between 2 and 5 years. A new SCS system with a rechargeable power source may last 10 to 25 years, or longer. The potential economic implications of longer battery life with a new SCS system has yet to be assessed. The study objective is to estimate the average difference in lifetime costs between rechargeable and nonrechargeable pulse generators used in treatment with SCS for failed back surgery syndrome. MethodsA generalized state-transition probability framework was used to model costs. Input parameters for the base case analysis were obtained from several data sources including published literature, Medicare fee schedules, Medicare claims data, and expert opinion. ResultsA rechargeable SCS system is projected to require from 2.6 to 4.2 fewer battery generator replacements for battery depletion than a nonrechargeable SCS system. The total lifetime savings of a rechargeable system range from

The impact of diabetes on clinical and economic outcomes of percutaneous coronary intervention in the elderly: A population-based analysis

104,000 to

Cost Effectiveness of Paclitaxel-Eluting Stents for Patients Undergoing Percutaneous Coronary Revascularization Results From the TAXUS-IV Trial

168,833. In all of the one-way sensitivity analyses conducted, a rechargeable system saves money. Among all of the assumptions underlying the analysis, the annual cost after device removal contributes the most uncertainty. ConclusionsA rechargeable SCS system is projected to save up to