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Resource Use Trajectories for Aged Medicare Beneficiaries with Complex Coronary Conditions

Authors

  • Jerome J. Federspiel A.B.,

    1. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Sally C. Stearns Ph.D.,

    Corresponding author
    • Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Laura P. D'Arcy Ph.D.,

    1. Mathematica Policy Research, Washington, DC
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  • Kimberley H. Geissler B.A.,

    1. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Christopher A. Beadles M.D.,

    1. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Daniel J. Crespin M.S.P.H.,

    1. Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
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  • Timothy S. Carey M.D., M.P.H.,

    1. School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
    2. Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Joseph S. Rossi M.D.,

    1. St. Vincent Medical Group, Indianapolis, IN
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  • Brett C. Sheridan M.D.

    1. Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Address correspondence to Sally C. Stearns, Ph.D., Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1104C McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599-7411; e-mail: sally_stearns@unc.edu.

Abstract

Objective

To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use.

Data Sources

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

Study Design

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.

Principal Findings

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.

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