The clinical and cost burden of coronary calcification in a Medicare cohort: An economic model to address under-reporting and misclassification.
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.


OBJECTIVES
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.
['Garrison|Louis P|LP|', 'Lewin|Jack|J|', 'Young|Christopher H|CH|', 'Généreux|Philippe|P|', 'Crittendon|Janna|J|', 'Mann|Marita R|MR|', 'Brindis|Ralph G|RG|']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D003324:Coronary Artery Disease D003951:Diagnostic Errors D005260:Female D017048:Health Care Costs D006801:Humans D015994:Incidence D038801:International Classification of Diseases D008297:Male D006278:Medicare D018803:Models, Economic D018579:Patient Selection D062645:Percutaneous Coronary Intervention D011237:Predictive Value of Tests D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome D014481:United States D061205:Vascular Calcification
Coronary Calcification Medicare Economics