Total First-Year Costs of Acute Coronary Syndrome in a Managed Care Setting

Etemad, Lida; McCollam, PL

doi:10.18553/jmcp.2005.11.4.300

Cited by 69 publications

(54 citation statements)

References 16 publications

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“…95,96 Cost-Effectiveness of Therapy Both the acute and long-term costs associated with cardiovascular events are high. [97][98][99][100] For example, in a managed care setting, the total first-year health care cost per patient after acute coronary syndrome was estimated at $22,529. 97 In another managed care study, the total average annualized health care costs for the treatment of peripheral artery disease was $5,955.…”

Section: Management Of Familial Hypercholesterolemia: a Review Of Thementioning

confidence: 99%

Management of Familial Hypercholesterolemia: A Review of the Recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia

Robinson

2013

JMCP

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suMMaRyFamilial hypercholesterolemia (FH) is a genetic disorder of lipid metabolism that is characterized by a significant elevation in levels of low-density lipoprotein cholesterol (LDL-C), and patients are at very high risk for premature coronary heart disease (CHD). The etiology of FH includes known mutations in the gene of the LDL receptor, LDLR ; the gene of apolipoprotein B, apo B ; and the proprotein convertase subtilisin/kexin type 9 gene, PCSK9. The National Lipid Association Expert Panel on Familial Hypercholesterolemia has provided recommendations for the screening and treatment of patients with FH. Early identification and aggressive treatment of FH in individual patients, as well as screening of all first-degree relatives, are recommended to minimize the risk for premature CHD. Similar to patients with conventional hypercholesterolemia, patients with FH should receive statins as initial treatment, but patients with FH may require higher doses of statins, more potent statins, statin-based combination therapy, or adjunctive therapies. Patients with FH who have additional risk factors for, or existing, cardiovascular disease or those with an inadequate response to initial statin therapy should have access to higher doses of the most efficacious statins; statins used in combination with other LDL-C-lowering agents should also be supported by formularies; additional treatments, such as LDL-C apheresis or novel therapies, may also be required to achieve acceptable LDL-C levels. New treatment approaches include mipomersen, which was approved by the FDA in January 2013. Mipomersen is an oligonucleotide inhibitor of apolipoprotein B-100 synthesis (called an antisense inhibitor) indicated as an adjunct to lipid-lowering medications and diet to reduce LDL-C, apolipoprotein B, total cholesterol, and non-high density lipoproteincholesterol (non-HDL-C) levels in patients with homozygous FH (HoFH). The microsomal transfer protein lomitapide has also received FDA approval for use only in patients with HoFH. Other novel treatments currently in development include PCSK9 inhibitors. Therapies such as apheresis are likely more expensive than simple therapy with a statin but may be needed to achieve long-term reductions in complications from nonfatal and fatal cardiovascular events and hospitalizations related to myocardial infarction, cardiac revascularization, and stroke in FH patients. The cost-effectiveness of this more aggressive therapy has not been determined and should be studied. Utilization of published guidelines and the recommendations from the National Lipid Association will help to optimize the management of patients with FH.

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Section: Management Of Familial Hypercholesterolemia: a Review Of Thementioning

confidence: 99%

Management of Familial Hypercholesterolemia: A Review of the Recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia

Robinson

2013

JMCP

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“…Nine studies (12,(35)(36)(37)(38)(39)(40)(41)(42) reported costs associated with CAD overall or specifically for myocardial infarction (MI), acute coronary syndrome (ACS) and angina. These studies are summarized in Table 5 and are discussed in more detail below.…”

Section: Cadmentioning

confidence: 99%

A review of the cost of cardiovascular disease

Tarride

Lim

DesMeules

et al. 2009

Canadian Journal of Cardiology

208

129

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“…14 Furthermore, patients with UA incur significant costs to the healthcare system, both in the short and long-term. 14,15 The composite of these studies suggest that UA is not benign and has significant impacts on the patient as well as the healthcare system. Thus, our finding, that chest pain during ETT is predictive of hospitalization for both MI and UA, is important with regard to both patient risk stratification and resource utilization.…”

Section: Discussionmentioning

confidence: 99%

Chest Pain on Exercise Treadmill Test Predicts Future Cardiac Hospitalizations

Rumsfeld

Peterson

et al. 2007

Clinical Cardiology

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Background: Patients often have chest pain during exercise treadmill testing (ETT). However, the evidence supporting chest pain as an independent adverse prognostic factor during ETT has been inconsistent. The objective of this study was to determine the importance of chest pain during ETT in predicting future nonfatal cardiac hospitalizations. Methods: This was a prospective cohort study of all patients undergoing ETT between July 2001 and June 2004 in a large managed care organization. The primary outcome of interest was nonfatal cardiac hospitalizations including myocardial infarction and unstable angina. Multivariable Cox proportional hazards regression assessed the independent association between chest pain during ETT and subsequent nonfatal cardiac hospitalizations, adjusting patient, clinical and other treadmill variables. Results: Of the 8,459 patients undergoing ETT, 697 (8.2%) patients had chest pain during the test. Patients with chest pain during ETT had more nonfatal cardiac hospitalizations compared to patients without chest pain (11.9% vs. 2.6%; p < 0.0001). In multivariable Cox regression analysis, patients with chest pain during ETT remained at significantly increased risk of nonfatal cardiac hospitalizations (HR 3.44; 95% CI 2.60–4.56). The association between chest pain and adverse outcomes was consistent among prespecified subgroups including patients without ST‐segment changes and with good functional capacity on ETT. Conclusions: Chest pain during ETT, even without ECG changes, predicts subsequent cardiac hospitalizations. Future studies should evaluate whether aggressive management of such patients can prevent subsequent hospitalizations. Copyright © 2007 Wiley Periodicals, Inc.

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Total First-Year Costs of Acute Coronary Syndrome in a Managed Care Setting

Cited by 69 publications

References 16 publications

Management of Familial Hypercholesterolemia: A Review of the Recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia

Management of Familial Hypercholesterolemia: A Review of the Recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia

A review of the cost of cardiovascular disease

Chest Pain on Exercise Treadmill Test Predicts Future Cardiac Hospitalizations

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