Influence of Age on Revascularization Related Costs of Hospitalization Among Patients of Stable Coronary Artery Disease

The legitimacy of expensive revascularization procedures in patients with stable coronary artery disease (CAD) remains to be seen. In this study, resource utilization was compared across age-group categories of patients with stable CAD who underwent revascularization. Fiscal year 2006 discharge data maintained by the Maryland Health Services Cost Review Commission were examined. Current Procedural Terminology codes 36.1x and 36.0x were used to identify patients who underwent coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), respectively. Patients with acute myocardial infarctions (International Classification of Diseases, Ninth Revision, Clinical Modification code 410.xx) were excluded to limit the study group to patients with stable CAD. Totals of 1,066, 2,909, 4,272, 4,514, and 1570 hospitalizations per 100,000 hospitalizations were observed in the age groups 40 to 50, 50 to 60, 60 to 70, 70 to 80, and ≥80 years, respectively. The costs of hospitalization were driven by length of stay and choice of revascularization procedure (CABG vs PCI). There was trend toward increasing total costs and longer hospital stays with increasing age (p for trend <0.001) in patients who underwent CABG. Although the adjusted costs and adjusted length of stay were significantly higher in the patients who underwent PCI who were aged ≥80 years than in those aged 40 to 50 years, the differences among other age-group categories were not statistically significant. In conclusion, older patients with stable CAD who undergo interventions represent a substantial expenditure. Hospitalization costs are driven by longer hospital stays and the choice of CABG compared to PCI. With data supporting aggressive medical management of such patients, it is advisable to rethink management strategies in these patients.