BACKGROUND: There are 10 million patients with angina in the United States (500,000 new diagnoses annually). Although clinical efficacy of angina treatments is understood, total costs of care and clinical outcomes for patients with chronic angina in different treatment protocols are unknown. OBJECTIVE: Our objective was to estimate total costs of care and revascularization rates for patients with poorly controlled angina who added either (1) long-acting nitrates, (2) beta blockers or calcium channel blockers, or (3) ranolazine to their therapy. STUDY DESIGN: We performed retrospective claims analysis using an index event involving change of therapy in which a new antiangina drug was added. METHODS: Using a large commercial insurance claims database, 4545 patients with angina with an index event (ie, change of antiangina therapy) and 6 months of continuous enrollment pre- and postindex event were identified. Using total cost of care and revascularization rates, we first compared preindex disease burden, medical care use, and total cost of care and components of total cost. We then compared unadjusted use and cost of care across treatment groups. Finally, we estimated regression models to predict postindex event total costs of care and revascularization rates. RESULTS: During the preindex period, the 3 comparison groups had similar health measures, medical care use, and total costs of care. During the postindex period, ranolazine users had lower revascularization rates (9.9%) than comparison patient groups (15.4%-20.4%, both Ps < 0.001). Ranolazine users had lower total costs of care ($13,961) than the nitrate group ($18,166, 30.0% higher; P < 0.001) and the beta blockers/calcium channel blockers group ($17,612, 26.6% higher; P = 0.002). CONCLUSIONS: Adding ranolazine to the treatment regimen of patients with poorly controlled angina was associated with lower rates of revascularization and lower total costs of care than for comparable patients, differences both statistically and clinically relevant.
BACKGROUND: There are 10 million patients with angina in the United States (500,000 new diagnoses annually). Although clinical efficacy of angina treatments is understood, total costs of care and clinical outcomes for patients with chronic angina in different treatment protocols are unknown. OBJECTIVE: Our objective was to estimate total costs of care and revascularization rates for patients with poorly controlled angina who added either (1) long-acting nitrates, (2) beta blockers or calcium channel blockers, or (3) ranolazine to their therapy. STUDY DESIGN: We performed retrospective claims analysis using an index event involving change of therapy in which a new antiangina drug was added. METHODS: Using a large commercial insurance claims database, 4545 patients with angina with an index event (ie, change of antiangina therapy) and 6 months of continuous enrollment pre- and postindex event were identified. Using total cost of care and revascularization rates, we first compared preindex disease burden, medical care use, and total cost of care and components of total cost. We then compared unadjusted use and cost of care across treatment groups. Finally, we estimated regression models to predict postindex event total costs of care and revascularization rates. RESULTS: During the preindex period, the 3 comparison groups had similar health measures, medical care use, and total costs of care. During the postindex period, ranolazine users had lower revascularization rates (9.9%) than comparison patient groups (15.4%-20.4%, both Ps < 0.001). Ranolazine users had lower total costs of care ($13,961) than the nitrate group ($18,166, 30.0% higher; P < 0.001) and the beta blockers/calcium channel blockers group ($17,612, 26.6% higher; P = 0.002). CONCLUSIONS: Adding ranolazine to the treatment regimen of patients with poorly controlled angina was associated with lower rates of revascularization and lower total costs of care than for comparable patients, differences both statistically and clinically relevant.
Authors: Georgia Kourlaba; Charalambos Vlachopoulos; John Parissis; John Kanakakis; George Gourzoulidis; Nikos Maniadakis Journal: BMC Health Serv Res Date: 2015-12-18 Impact factor: 2.655
Authors: Mina Owlia; John A Dodson; Jordan B King; Catherine G Derington; Jennifer S Herrick; Steven P Sedlis; Jacob Crook; Scott L DuVall; Joanne LaFleur; Richard Nelson; Olga V Patterson; Rashmee U Shah; Adam P Bress Journal: J Am Heart Assoc Date: 2019-07-31 Impact factor: 5.501