冠動脈CT血管図やストレステストの関連性,その後のメディケア受給者の利用と支出
Jacqueline Baras Shreibati1, Laurence C Baker, Mark A Hlatky
1Stanford University School of Medicine, Stanford, CA 94305-5405, USA.
JAMA
|November 18, 2011
まとめ
冠動脈コンピュータトモグラフィー血管図 (CCTA) は,メディケア患者のストレステストと比較して,より侵襲的な心臓の手術と高額な支出につながる. この解剖学的検査アプローチは,死亡率の結果を大幅に変更することなく,コストを増加させます.
科学分野:
- 心臓病学 心臓病学
- 医療サービス 研究 医療サービス
- メディカルイマージング (医学イメージング)
背景:
- 冠動脈コンピュータトモグラフィー血管図 (CCTA) は,冠動脈疾患 (CAD) の新興の非侵襲的診断ツールです.
- CCTAと,その後の臨床管理と医療費との関連性は,まだ十分に研究されていない.
研究 の 目的:
- 機能的 (ストレステスト) と解剖的 (CCTA) の非侵襲的な心臓検査の利用と関連する医療費を比較する.
- メディケア集団における下流の臨床管理とコストを分析する.
主な方法:
- メディケアサービス料金請求データ (2005年-2008年) を利用した遡及的観察コホート研究.
- 以前のCAD請求書のない66歳以上の受益者を含め,非発現性非侵襲的なCAD検査 (n=282,830) を受けた.
- 結果には,心経キャセテリゼーション,再血管化,心筋梗塞,死亡率,そして180日間のメディケア支出が含まれていました.
主要な成果:
- CCTAの使用は,ストレス心筋 perfusion scintigraphy (MPS) と比較して,その後の心筋キャセテリゼーション,皮膚経冠動脈介入,冠動脈バイパス移植手術の有意に高い割合と関連していました.
- CCTAは,主にCADに関連するクレームによって引き起こされる,実質的に高い医療費総額と関連していました.
- CCTAはあらゆる原因による死亡率に類似しているが,MPSと比較して急性心筋梗塞の入院率が低いとの関連があった.
結論:
- 非急性でCCTAを受けたMedicareの受給者は,侵襲的な心臓の手術の割合が増加しました.
- CCTAは,従来のストレステストと比較して,CADに関連する医療費が著しく高かったと関連していました.
- この発見は,下流管理の違いと,解剖学的および機能的な非侵襲的な心臓検査のコストの影響を強調しています.
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