The Role of Technology in Cardiovascular Health Care Cost Growth 4.21.10
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New technologies like drug-eluting stents and implantable cardioverter-defibrillators significantly increased healthcare costs for Medicare beneficiaries between 2003-2006, adding nearly $4 billion annually. While these technologies provided benefits, they disproportionately drove up costs for lower-acuity patients. The study found that 43% of increased costs from drug-eluting stents were for patients without acute coronary syndromes, and growth in costs from implantable cardioverter-defibrillators for non-hospitalized heart failure patients was minimal. Technologies that increase spending most for low-acuity cases may not be providing optimal value.
![The Role of Technology in Cardiovascular Health Care Cost Growth Peter W. Groeneveld, MD, MS · Andrew J. Epstein, PhD, MPP · Lin Yang, MS · Feifei Yang, MS · Mollie Epstein, MA · Daniel Polsky, PhD Philadelphia VA Medical Center; Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine; Division of Health Policy and Administration, Yale School of Public Health Background Objectives Methods Results (continued) Conclusions Implications Results Methods (continued) a $millions (2006 dollars) a Number (%) unless otherwise indicated. Percentages may not sum to 100 due to rounding. b Annual cohorts sum to a larger number than the total 5-year cohort size (column n ) because some patients were members of more than one annual cohort. c Percentage of CAD patients receiving DES during calendar year; percentage of HF patients receiving ICD/CRTs during calendar year. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Patients in Study a ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Coronary Artery Disease Cohorts Heart Failure Cohorts AMI (n=72,336) Non-infarct ACS (n=51,768) Non-ACS (n=678,995) Hospitalized Primary HF (n=77,368) Hospitalized Secndry HF (n=179,912) Non-hosp HF (n=307,434) age (mean, std) 76 (5) 75 (5) 74 (6) 77 (6) 77 (6) 76 (6) female 34,331 (48) 24,070 (47) 348,660 (51) 41,376 (54) 97,838 (54) 171,316 (56) Race black 5,660 (8) 3,812 (7) 53,601 (8) 8,855 (11) 17,173 (10) 30,947 (10) white 63,520 (88) 45,568 (88) 588,282 (87) 65,338 (85) 155,721 (87) 257,903 (84) other 3,156 (4) 2,388 (5) 37,112 (6) 3,175 (4) 7,018 (4) 18,584 (6) U.S. Census Region northeast 14,791 (20) 9,257 (18) 146,518 (22) 15,271 (20) 33,614 (19) 65,196 (21) south 29,339 (41) 23,228 (45) 269,984 (40) 32,882 (43) 74,443 (42) 120,302 (39) midwest 18,825 (26) 13,048 (25) 164,477 (24) 20,128 (26) 48,043 (27) 73,298 (24) west 9,381 (13) 6,235 (12) 98,016 (14) 9,087 (12) 23,812 (13) 48,638 (16) Year 2002 b 19,059 (21) 15,294 (23) 348,921 (19) 22,851 (21) 59,293 (23) 121,687 (19) 2003 b 19,141 (21) 14,417 (21) 357,233 (20) 23,265 (21) 61,128 (21) 120,417 (20) 2004 b 17,543 (20) 13,660 (20) 366,276 (20) 22,318 (20) 61,010 (20) 121,612 (20) 2005 b 17,461 (19) 12,736 (19) 375,618 (21) 22,441 (19) 63,659 (19) 122,735 (21) 2006 b 16,504 (18) 11,217 (17) 376,008 (21) 20,933 (18) 63,070 (17) 121,177 (21) DxCG risk score (mean, std) 5.3 (3.4) 3.6 (2.9) 2.0 (2.7) 5.1 (3.9) 4.8 (4.1) 2.6 (3.1) Device c rate, ‘02 0.02 0.03 0.01 2.5 0.9 0.17 Device c rate, ‘06 23.1 28.9 1.1 6.6 1.2 0.21 Spending Increases for CAD Patients Ages 66-85 Attributable to DES: 2002-2006 Subgroup N (2006) Total 2006 Cost a $Δ 2002-06: DES a %Δ 2002-06: DES Subgroup Share (%) Acute MI 330,080 12,327 1,173 (955–1,404) 8.6 (7.0–10.3) 38 Non-AMI ACS 224,340 6,069 569 (449–692) 7.0 (5.6–8.6) 19 Non-ACS 7,520,160 84,324 1,339 (868–1,782) 1.9 (1.2–2.5) 43 TOTAL 8,074,580 102,719 3,081 (2,560–3,591) 3.3 (2.8–3.9) 100 Spending Increases for HF Patients Ages 66-85 Attributable to ICDs: 2002-2006 Subgroup N (2006) Total 2006 Cost a $Δ 2002-06 : ICDs a %Δ 2002-06 : ICDs Subgroup Share (%) Primary Hosp 418,660 14,768 571 (478–672) 3.8 (3.2–4.5) 80 Secondary Hosp 1,261,400 31,236 121 (43–200) 0.4 (0.2–0.7) 17 Non-Hosp 2,423,540 29,383 23 (-35–79) 0.1 (-0.1–0.3) 3 TOTAL 4,103,600 75,387 715 (582–860) 1.0 (0.8–1.2) 100](https://image.slidesharecdn.com/groeneveldpete-theroleoftechnologyincardiovascularhealthcarecostgrowth-4-21-10-100818152217-phpapp01/85/The-Role-of-Technology-in-Cardiovascular-Health-Care-Cost-Growth-4-21-10-1-320.jpg)
