Cost of care for new-onset acute coronary syndrome patients who undergo coronary revascularization.

OBJECTIVES: This study examines demographic, health characteristics, and total health care utilization in acute coronary syndrome (ACS) patients who underwent coronary revascularization within the first year of follow-up.

BACKGROUND: Revascularization during or after the index ACS event is becoming more common, and it is important to further characterize these patients.

METHODS: A retrospective claims analysis was conducted (July 1, 1999-June 30, 2001) with new onset ACS patients, defined as an emergency room visit or hospitalization with an ICD-9 code for unstable angina (UA) or acute myocardial infarction (AMI), but without an ACS claim in the previous 6 months. Patients were followed up to 12 months to identify total resource utilization (medical, pharmacy, revascularization procedures).

RESULTS: A total of 6,929 patients were included and 69% had revascularization performed during the index hospitalization. Mean age was 55 years; 72.9% were male. Revascularization was percutaneous coronary intervention (PCI) in 5,002 and bypass surgery in 1,927. The index ACS event was AMI in 48.9%; 13.5% had both AMI and UA. Total first-year cost was 210.7 million dollars (30,402 dollars per patient); hospitalization costs were 161.7 million dollars (23,331 dollars per patient). During follow-up, 75.5% received a statin, 75.8% a beta-blocker, and 63.5% of all patients received clopidogrel (84.8% of PCI patients). Mean days of clopidogrel therapy were 83.5.

CONCLUSIONS: Early revascularization is a frequent therapeutic strategy in these relatively young managed care patients. The majority of costs were medical and a majority of procedures were PCI. Many patients experienced AMI as their initial cardiovascular event. Drug utilization of statins, beta-blockers, and clopidogrel, according to practice guidelines, was acceptable.