Autor: Peter Buser, Matthias Pfisterer, Christoph Gradel, Thomas D. Szucs, Christian Schindler, Gabriela M. Kuster, Matthias Schwenkglenks, Werner Estlinbaum, Jacques Claude, Christoph Kaiser, Peter Rickenbacher, Stefan Osswald
Rok vydání: 2004
Předmět:
Zdroj: European Heart Journal. 25:2195-2203
ISSN: 0195-668X
DOI: 10.1016/j.ehj.2004.09.013
Popis: Aim To compare benefits and costs of invasive versus medical management in elderly patients with chronic angina. Methods and results In a predefined subgroup of 188 patients of the Trial of Invasive versus Medical therapy in Elderly patients with chronic angina (TIME), one-year benefits were assessed as freedom from major events and improvements in symptoms and quality of live. Costs were determined as one-year costs of resource utilisation. Invasive patients had higher 30-day, but lower months 2–12 hospital and intervention costs than medical patients, resulting in somewhat higher one-year costs for invasive management ( p =0.08). However, billing data available for a subgroup of patients showed higher practitioner's charges in the medical patients (adjusted p =0.0015). Incremental costs to prevent one major event by invasive management averaged CHF 10100 (95% CI: −800 to 28300) or € 6965, ranging from average CHF 5100 (€ 3515) to CHF 11600 (€ 8000) in a best, compared to a worst, case scenario. Conclusions Early increased costs of revascularization in invasive patients were balanced after one year by increased practitioners' charges and symptom-driven late revascularizations in medical patients. Therefore, the invasive strategy with improved clinical effectiveness at only marginally higher costs as medical management was cost-effective. Costs should not be an argument against invasive management of elderly patients with chronic angina.
Databáze: OpenAIRE
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