Evidence map›Paper›PMID 25664611›Full record

ReviewHealth services research2015

Does Higher Spending Improve Survival Outcomes for Myocardial Infarction? Examining the Cost-Outcomes Relationship Using Time-Varying Covariates.

Deborah Cohen, Douglas G Manuel, Peter Tugwell, Claudia Sanmartin, Tim Ramsay

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Health services research, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Healthcare spending in the State of Louisiana.BMC health services research · 2019
    Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Deborah CohenDepartment of Population Health, University of Ottawa, Institute for Clinical Evaluative Sciences, 35 Soho Crescent, Ottawa, ON, Canada, K1N6N5.
Douglas G ManuelOttawa Hospital Research Institute, University of Ottawa, Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada.
Peter TugwellCentre for Global Health, Institute of Population Health, Ottawa Health Research Institute, University of Ottawa, Ottawa, ON, Canada.
Claudia SanmartinHealth Analysis Division, Statistics Canada, Ottawa, ON, Canada.
Tim RamsayOttawa Hospital Research Institute, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada.

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

objectivesPrevious patient-level acute myocardial infarction (AMI) research has found higher hospital spending to be associated with improved survival; however, survivor-treatment selection bias traditionally has been overlooked. The purpose of this study was to examine the AMI cost-outcome relationship, taking into account this form of bias. DATA SOURCES: Hospital Discharge Abstract data tracked costs for AMI hospitalizations. Ontario Vital Statistics data tracked patient mortality. STUDY

designA standard Cox survival model was compared to an extended Cox model using hospital costs as a time-varying covariate to examine the impact of cost on 1-year survival in a cohort of 30,939 first-time AMI patients in Ontario, Canada, from 2007 to 2010. PRINCIPAL

findingsHigher patient-level AMI spending decreased the hazard of dying (Standard Model: log-cost hazard ratio: 0.513, 95 percent CI: 0.479-0.549; Extended Model: log-cost hazard ratio: 0.700, 95 percent CI: 0.645-0.758); however, the protective effect was overestimated by 62 percent when survivor-treatment bias was overlooked. In the extended model, a 10 percent increase in spending was associated with a 3.6 percent decrease in hazard of death.

conclusionThe findings of this study suggest that if survivor-treatment bias is overlooked, future research may materially overstate the protective effect of patient-level spending on outcomes.

Indexed as

AdultAgedAged, 80 and overCosts and Cost AnalysisEconomics, HospitalFemaleHospital Distribution SystemsHumansLength of StayMaleMiddle AgedMyocardial InfarctionOntarioOutcome Assessment, Health CarePatient ReadmissionProportional Hazards Modelscost-outcome relationshipsMyocardial infarctionsurvivor-treatment selection biastime-varying covariates

Identifiers

PMID25664611
PMCPMC4600363

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.