Reduced Health Care Expenditures After Enrollment in a Collaborative Cardiac Care Service
1Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado.
Kari L. Olson, Pharm.D., 2
2Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado; Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente Colorado, Aurora, Colorado; University of Colorado School of Pharmacy, Aurora, Colorado.
Jon Rasmussen, Pharm.D., 3
3Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado; Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente Colorado, Aurora, Colorado; University of Colorado School of Pharmacy, Aurora, Colorado.
Kara Hutka, Pharm.D., 4
4Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado; Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente Colorado, Aurora, Colorado; University of Colorado School of Pharmacy, Aurora, Colorado.
Brian Sandhoff, Pharm.D., 5
5Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado; Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente Colorado, Aurora, Colorado; University of Colorado School of Pharmacy, Aurora, Colorado.
Roseanne Hornak, Pharm.D., 6
6Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado; Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente Colorado, Aurora, Colorado; University of Colorado School of Pharmacy, Aurora, Colorado.
John Merenich, M.D., 7
7Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente Colorado, Aurora, Colorado; Clinical Informatics Decision Support, Denver, Colorado.
Clinical Pharmacy Cardiac Risk Service Study Group
Study Objective. To assess the impact of a collaborative cardiovascular risk reduction service (Collaborative Cardiac Care Service [CCCS]) on total health care expenditures after an incident acute coronary event.
Design. Matched, retrospective cohort study.
Data Source. Kaiser Permanente Colorado (KPCO) databases.
Patients. Patients who had an incident coronary event between January 1999 and June 2004 and were either enrolled (CCCS group) or never enrolled in the CCCS (No CCCS group). Patients in the CCCS group (628 patients) were matched in a 1:1 ratio to patients in the No CCCS group (628 patients) by Chronic Disease Score (CDS) and total health care expenditures in the 180 days before the index coronary event (baseline).
Measurements and Main Results. Drug purchases and medical utilization encounters were extracted from the KPCO administrative and claims databases after the incident coronary event until death, KPCO plan termination, 3 years later, or December 31, 2005, whichever came first (follow-up). Expenditure estimates from the plan's decision support system (in 2007 U.S. dollars) were applied to each utilization encounter. A $1/follow-up day cost was applied to all patients in the CCCS group. Expenditures/follow-up day were modeled with adjustment for matching variables, patient characteristics, baseline expenditures, and intracorrelations of matched patients. Patients in the No CCCS group were slightly older and were more likely to be female and have had a myocardial infarction as their incident event compared with those in the CCCS group. During follow-up, there were 12 and 98 cardiac-related deaths and 16 and 188 all-cause deaths for the CCCS and No CCCS groups, respectively; mean and median total health care expenditures/day were $39 and $20, respectively, for the CCCS group, and $108 and $45, respectively, for the No CCCS group (all p<0.001). After adjustment, total health care expenditures for patients in the CCCS group were approximately $60/day ($21,900/yr) lower than those for patients in the No CCCS group (p<0.001; adjusted R2=0.29 with log-transformed expenditures).
Conclusion. The comprehensive and aggressive implementation of secondary cardiac prevention strategies and close monitoring and follow-up of patients with coronary artery disease provided by the CCCS were associated with reduced health care expenditures.