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

Background-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. Methods and Results-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 greater than or equal to65 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 greater than or equal to1 repeat revascularization procedures. Mean 1-year medical care costs increased 5-fold among patients with repeat revascularization compared with those without ($26 186 versus $5344; P<0.001). After adjustment for baseline differences, the independent cost of repeat revascularization was $19 074 (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 per initial PCI procedure. Conclusions-Among unselected elderly patients undergoing PCI, repeat revascularization occurs in approximate to 14% and increases 1-year healthcare costs by >$19 000 per occurrence. These findings have important implications for the cost-effectiveness of new treatments that substantially reduce restenosis.