DES Make Up
Sizeable Chunk Of Rising Medicare Costs For CAD Patients
Drug-eluting stents (DES) are responsible for almost
two-thirds of the increase in Medicare costs for all coronary artery disease
(CAD) patients from 2003 to 2006. The sum amounts to over $3 billion, according
to findings presented May 20, 2010, at the American Heart Associationís Quality
of Care and Outcomes Research in Cardiovascular Disease and Stroke 2010
Scientific Sessions in Washington, DC.
By comparison, implantable cardioverter
defibrillators (ICDs) are responsible for only 15% of the increase in Medicare
costs for the chronic heart failure population over the same time period.
Researchers led by Peter W. Groeneveld, MD, MS, of
the Philadelphia Veterans Affairs Medical Center (Philadelphia, PA), looked at
Medicare claims from 2003 to 2006, identifying patients ages 66 to 85 in each
year diagnosed either with CAD or chronic heart failure. They then calculated
the annual average cost of care, as well as the average use rate of DES and ICDs
in the 2 disease populations. The analysis included a measure of the annual
change in costs for non-cardiovascular disease to control for increases
unrelated to the devices.
The researchers found that the average
inflation-adjusted costs for CAD patients increased from $12,160 in 2003 to
$12,721 in 2006, while the average cost for chronic heart failure patients
increased from $17,153 to $18,371 over the same time period. Meanwhile, the
average cost increase for CAD patients treated with DES was $412, while the
average cost increase for heart failure patients with ICDs was $189.
Over the course of the study, the total cost
increase attributable to DES in the overall Medicare CAD population ages 66 to
85 was $3.32 billion, representing 73% of the total increase. The total cost
increase in the Medicare heart failure population attributable to ICDs,
meanwhile, was $774 million and worked out to just 15% of the overall increase.
The ICDs have increased cost in direct proportion to
how many devices are used, but DES have really amplified the cost well beyond
the additional cost of the technology itself. Hence , medicine actually changes
when new technology appears, and that clearly seems to be the case with DES with
regard to patterns of care. It was noted by doctors that that changes associated
with DES included upswings in imaging exams, diagnostic cardiac
catheterizations, physician referrals, subspecialist evaluations, and elective