冠状动脉CT血管造影或压力测试与随后的使用和支出在医疗保险受益人的关联
Jacqueline Baras Shreibati1, Laurence C Baker, Mark A Hlatky
1Stanford University School of Medicine, Stanford, CA 94305-5405, USA.
JAMA
|November 18, 2011
概括
冠状动脉计算机断层扫描血管造影 (CCTA) 导致医疗保险患者的心脏手术更具侵入性,与压力测试相比,支出更高. 这种解剖测试方法增加了成本,但没有显著改变死亡率的结果.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 医疗成像医学成像
背景情况:
- 冠状动脉计算机断层扫描血管学 (CCTA) 是冠状动脉疾病 (CAD) 的新兴非侵入性诊断工具.
- CCTA与随后的临床管理和医疗保健支出之间的关联仍未得到充分研究.
研究的目的:
- 为了比较功能性 (压力测试) 与解剖性 (CCTA) 非侵入性心脏测试的利用率和相关的医疗保健支出.
- 分析医疗保险群体下游临床管理和成本.
主要方法:
- 使用Medicare服务费索赔数据 (2005-2008) 的回顾性观察队列研究.
- 包括66岁以上的受益者,没有先前的CAD索赔,接受了非突发性,非侵入性CAD测试 (n=282,830).
- 结果包括心脏导管,再血管,心肌梗塞,死亡率和医疗保险支出超过180天.
主要成果:
- 与应力心肌 perfusion scintigraphy (MPS) 相比,CCTA的使用与随后的心脏导管,皮肤冠状动脉干预和冠状动脉旁路移植手术的显著更高率有关.
- CCTA与医疗保健总支出大幅增加有关,主要是由于CAD相关的索赔.
- 虽然CCTA显示了类似的全因死亡率,但与MPS相比,它与急性心肌梗塞住院的可能性较低.
结论:
- 在非急性情况下接受CCTA的医疗保险受益人经历了侵袭性心脏手术的增加率.
- 与传统压力测试相比,CCTA与CAD相关的医疗保健支出显著增加有关.
- 这些发现突出了解剖学和功能性非侵入性心脏检测之间的下游管理和成本影响的差异.
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