Clinical and economic outcomes of percutaneous coronary interventions in the elderly: an analysis of medicare claims data.

Abstract

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. 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 > or =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 > or =1 repeat revascularization procedures. Mean 1-year medical care costs increased 5-fold among patients with repeat revascularization compared with those without (26,186 dollars versus 5344 dollars; P<0.001). After adjustment for baseline differences, the independent cost of repeat revascularization was 19,074 dollars (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 2747 dollars per initial PCI procedure. Among unselected elderly patients undergoing PCI, repeat revascularization occurs in approximately 14% and increases 1-year healthcare costs by >19,000 dollars per occurrence. These findings have important implications for the cost-effectiveness of new treatments that substantially reduce restenosis.