IngentaConnect Predictors of high-cost managed care patients with acute coronary...

Abstract:

Objective: To develop predictive models of high-cost acute coronary syndrome (ACS) patients using demographic, disease, and treatment characteristics.

Study design: This was a retrospective, administrative claims analysis utilizing pharmacy, medical, and eligibility data from a large US managed care organization.

Methods: ACS was defined by ICD-9 codes for unstable angina (UA) or acute myocardial infarction (AMI). New onset patients (without ACS claims) in the prior six months were identified for the time period 07/01/99–06/30/01, and followed up to 12 months, health plan disenrollment, or death. Cost was measured as that incurred during the initial episode plus subsequent follow-up or during the subsequent follow-up only. Patients were dichotomized as high-cost (top 20%) or low-cost (bottom 80%), based on total costs. Logistic regression was used to examine the association for being classified as high-cost.

Results: A total of 13 731 patients were included: 51.7% with UA, 39.6% with AMI and 8.7% with both UA and AMI. The mean age was 54.2 years and 68.2% were male. A number of co-morbidities (hypertension, diabetes, heart failure, etc.) predicted high-cost patients. Among medications, prior ACE inhibitor use predicted high-cost patients. While revascularization procedures, in general, were strong predictors of high-cost, revascularization during the index ACS episode (opposed to revascularization during the follow-up) decreased the odds of being high-cost (odds ratio [95% CI] 0.615 [0.506–0.748]).

Conclusion: High-cost patients with new onset ACS can be predicted by some characteristics, but many of these characteristics are non-modifiable co-morbidities. Payers and providers may find opportunities for clinical and cost-saving interventions for these patients.

Keywords: ANGINA, UNSTABLE; HEALTH EXPENDITURES; HEALTH MAINTENANCE ORGANIZATION; MYOCARDIAL INFARCTION

Document Type: Research article

DOI: 10.1185/030079905X74970

Affiliations: 1: i3 Magnifi, an Ingenix Company, 12125 Technology Dr., Eden Prairie, MN 55344, USA 2: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA

The full text electronic article is available for purchase. You will be able to download the full text electronic article after payment.

$51.50 plus tax Refund Policy

Predictors of high-cost managed care patients with acute coronary syndrome