Predictors of high-cost managed care patients with acute coronary syndrome

Etemad, Lida; McCollam, PL

doi:10.1185/030079905x74970

Cited by 13 publications

(10 citation statements)

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“…This study used methodology similar to the approach described by Etemad and McCollam in an article examining predictors of HC managed care patients with acute coronary syndrome [13]. Etemad and McCollam identified patients with newly onset acute coronary syndrome and assessed these patients’ health care costs over 12 months after disease onset.…”

Section: Discussionmentioning

confidence: 99%

“…We wished to evaluate whether this rule held true in a T2DM population. Second, previous studies examining HC patients in other disease areas have used similar methodology [13]. We also felt that it was important to see if patient characteristics changed as we went from the top 20% of patients to the top 10% of patients.…”

Section: Methodsmentioning

confidence: 99%

“…Further, identifying T2DM patients who could be considered high cost (HC) is of significant interest to health care payers, given the rising health care costs in the US—interventions could be developed that would focus on patients who are likely to become HC and therefore minimize costs of the disease. Previous studies have identified HC patients in other disease areas (e.g., acute coronary syndromes) [13]; but to our knowledge, no retrospective analysis has been published that examines HC patients with T2DM.…”

Section: Introductionmentioning

confidence: 99%

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The high-cost, type 2 diabetes mellitus patient: an analysis of managed care administrative data

et al. 2014

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BackgroundType 2 diabetes mellitus (T2DM) affects 25.8 million individuals in the United States and exerts a substantial economic burden on patients, health care systems, and society. Few studies have categorized costs and resource use at the patient level. The goals of this study were to assess predictors of being a high-cost (HC) patient and compare HC T2DM patients with not high-cost (NHC) T2DM patients.MethodsUsing managed care administrative claims data, patients with two or more T2DM diagnoses between 2005 and 2010 were selected. Patients were followed for 1 year after their first observed T2DM diagnosis; patients not continuously enrolled during this period were excluded from the study. Study measures included annual health care expenditures by component (i.e., inpatient, outpatient, pharmacy, total). Patients accruing total costs in the top 10% of the overall cost distribution (i.e., patients with costs > $20,528) were classified as HC a priori; all other patients were considered NHC. To assess predictors of being HC, a logistic regression model was estimated, accounting for demographics; underlying comorbidity burden (using the Charlson Comorbidity Index [CCI] score); diagnoses of renal impairment, obesity, or hypertension; and receipt of insulin, oral antidiabetics only, or no antidiabetics.ResultsA total of 1,720,041 patients met the inclusion criteria; 172,004 were HC. The mean (SD) CCI score for HC patients was 4.3 (3.0) versus 2.1 (1.7) for NHC patients. Mean (SD; upper 95% confidence interval-lower 95% confidence interval) annual per-patient costs were $56,468 ($65,604; $56,778-$56,157) among HC patients and $4,674 ($4,504; $4,695-$4,652) among NHC patients. Inpatient care and pharmacy costs were higher for HC patients than for NHC patients. The strongest predictor of being an HC patient was having a CCI score of 2 or greater (odds ratio [OR] = 4.896), followed by a diagnosis of obesity (OR = 2.106), renal impairment (OR = 2.368), and insulin use (OR = 2.098).ConclusionsHigh-cost T2DM patients accrue approximately $52,000 more in total annual health care costs than not high-cost T2DM patients. Patients were significantly more likely to be high-cost if they had comorbid conditions, a diagnosis of obesity, or used insulin.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The high-cost, type 2 diabetes mellitus patient: an analysis of managed care administrative data

et al. 2014

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“…As expected, and in accordance with other studies, the decision to provide PCI procedures is associated with significantly increased hospital costs. Expensive PTCA and stenting procedures are particularly strong predictors of high hospitalisation costs (Etemad and McCollam, 2005;Evans et al, 2007;Kauf et al, 2006). These procedures require special skills and high-tech facilities, which are associated with significant investments in infrastructure and lead to substantial running costs.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients were only included in the study if they presented to an emergency department within 2 h of symptom onset with acute, prolonged chest pain. Diagnostic procedures also had to show the ECG alterations and cardiac troponin elevations typically associated with a clinical presentation of myocardial infarction (Etemad and McCollam, 2005). We excluded bypass surgery from our analysis due to the increased length of stay (LOS) and higher hospitalisation costs associated with this procedure.…”

Section: Case Description and Data Collectionmentioning

confidence: 99%

Variations in hospitalisation costs for acute myocardial infarction – a comparison across Europe

Tiemann¹

2008

Health Econ.

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SUMMARYThe aim of this study was to determine whether between-country variations in hospital costs are larger than withincountry variations and, furthermore, to explore reasons for this variability. For this purpose, we chose the primary treatment of patients with acute myocardial infarction (AMI) as an episode of care. We obtained hospitalisation costs and reimbursement rates from 45 hospitals in nine different EU member states (i.e. Denmark, England, France, Germany, Hungary, Italy, Netherlands, Poland, and Spain) for the year 2005. To further analyse the variations in hospital costs, we employed a hierarchical random effects model based on treatment and hospital characteristics and using purchasing power parities (PPPs) as a proxy for country-specific price levels. The betweencountry standard error was estimated at h2473; whereas the within-country standard error was estimated at h1242: Our regression analysis showed that percutaneous coronary intervention was associated with significantly increased hospitals costs compared to other treatment strategies. We were able to distinguish between three groups of countries with different cost levels based on the number of hospitals that were able to provide these services (i.e. percutaneous transluminal coronary angioplasty (PTCA) with intracoronary stenting). Excluding Hungary, Poland, and Spain, where none of the participating hospitals were able to provide these procedures, the betweencountry standard error decreased to h1632; whereas the within-country standard error increased to h1416: Finally, we observed exogenous price-level effects between countries and within countries for hospitals located in urban areas.

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Decreased mortality in a rat model of acute postinfarction heart failure

Råmunddal

Lorentzon

Ömerovic

2006

Biochemical and Biophysical Research Communications

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Predictors of high-cost managed care patients with acute coronary syndrome

Abstract: High-cost patients with new onset ACS can be predicted by some characteristics, but many of these characteristics are non-modifiable co-morbidities. Payers and providers may find opportunities for clinical and cost-saving interventions for these patients.

Cited by 13 publications

References 11 publications

The high-cost, type 2 diabetes mellitus patient: an analysis of managed care administrative data

The high-cost, type 2 diabetes mellitus patient: an analysis of managed care administrative data

Variations in hospitalisation costs for acute myocardial infarction – a comparison across Europe

Decreased mortality in a rat model of acute postinfarction heart failure

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