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- W1976123273 abstract "Background: Intravenous (IV) inotropic therapy (INO) remains controversial: chronic continuous (C) and intermittent (I) use are considered ACC/AHA IIb and III indications, respectively. Medicare (MED) covers 80% of allowed outpatient drug costs charged to a beneficiary (bene) when central IV access is used and acute hemodynamic improvement is demonstrated. However, no analysis of cost in this patient population has been performed to date. Methods: Data was collected on MED patients (n = 144) who had been approved for INO between 6/96 and 4/02 in a 17-state MED region (DMERC-D), limited to benes ≥66 years of age. The amount reimbursed for each hospitalization was abstracted from the Health Insurance Master Record; line item accounting of outpatient costs for INO/supplies were abstracted from Beneficiary Update and Display System forms. Descriptive statistical analysis was performed with corrections made for differential duration of follow-up. Results: The mean age of benes was 75.1±5.6 years (range 66-88y); total follow-up to death or last known alive in this cohort was 53720 days (mean 493±514d, range 2-1959d). The cohort was predominantly male (73.2%); most were treated with continuous dobutamine (71%) and cardiac index improved from 1.03 to 1.65 L/min. Background therapy included ACE inhibitor (56.3%); digoxin (38.4%) and nitrates (21.4%). The median reimbursed amount per bene for INO and supplies was $8966 (mean $30730±74519) with significant variability due in part to wide variation in survival rates; inpatient reimbursed amounts for inpatient care averaged $574±911d for each day the bene was alive following initiation of INO. Conclusions: Use of chronic INO in elderly MED benes is associated with considerable costs on a per diem basis; further analyses are required to determine if cost savings accrue in this advanced HF cohort when comparision is made to the period immediately prior to initiation of INO and to establish predictors of high utilization of resources post INO initiation." @default.
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- W1976123273 date "2004-08-01" @default.
- W1976123273 modified "2023-09-25" @default.
- W1976123273 title "Preliminary economic analysis of chronic continuous home inotropic therapy in end-stage heart failure: insights from a multi-state medicare data base" @default.
- W1976123273 doi "https://doi.org/10.1016/j.cardfail.2004.06.338" @default.
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