Abstract
Background: While early and aggressive comprehensive cardiac care (CCC) programs in patients with coronary artery disease (CAD) have been associated with improvements in clinical outcomes, information on the financial outcomes of such programs are limited. The purpose of this investigation was to assess the financial impact of a CCC program on total healthcare expenditures after an initial coronary event.
Methods: This was a matched, retrospective cohort analysis of the Kaiser Permanente Colorado (KPCO), a group model HMO, nurseand pharmacist-managed CCC program that was designed to provide evidence-based lifestyle and medication support at the earliest opportunity after a coronary event. Patients with an incident occlusive CAD event between January 1999 and June 2004 were categorized into intervention and comparator groups, respectively, by enrollment or never enrollment (No CCC) into the CCC. Patients were matched 1:1 on chronic disease score (CDS) and 180-day pre-coronary event (baseline) total healthcare expenditures. Pharmacy and medical utilization events were extracted from electronic administrative and claims databases. Utilization events were collected after the initial coronary event until death, health plan termination, three years, or December 31, 2005, whichever came first (follow up). Expenditure estimates from the KPCO Decision Support System (in 2007 dollars) were applied to utilization events. An intervention cost of $1/ follow-up-day was applied to all CCC patients. Expenditures/day were modeled with adjustment for matching variables, patient characteristics, baseline expenditures, and intra-correlations of matched patients.
Results: 628 CCC patients were matched to 628 No CCC patients. Patients in the No CCC group were slightly older, more likely to be female, and to have had a myocardial infarction. Mean/median baseline expenditures and CDS were equivalent. During follow-up, 12 and 98 cardiac-related deaths occurred in and mean/median total healthcare expenditures/day were $57/$30 and $159/$45 for the CCC and No CCC groups, respectively (both P<0.001). After adjustment, CCC patients were associated with -$103/day lower total healthcare expenditures (P<0.001; adjusted R-square=0.71 with log-transformed expenditures).
Conclusions: Comprehensive and aggressive implementation of secondary cardiac prevention strategies with close monitoring and follow-up of CAD patients is associated with reduced healthcare expenditures.
