Evidence map›Paper›PMID 27730104›Full record

ArticleCMAJ open

Relation between initial treatment strategy in stable coronary artery disease and 1-year costs in Ontario: a population-based cohort study.

Jaskaran S Kang, Maria C Bennell, Feng Qiu, Merril L Knudtson, Peter C Austin, Dennis T Ko, Harindra C Wijeysundera

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.6field-weighted citation impact, top 27% of its field
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

4 citing papers in PubMed, 4 citations in OpenAlex.

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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

7 authors at 2 institutions in 1 country.

Jaskaran S KangDivision of Cardiology (Kang, Bennell, Ko, Wijeysundera), Sunnybrook Health Sciences Centre, Schulich Heart Centre, University of Toronto; Institute for Clinical Evaluative Sciences (Qiu, Austin, Ko, Wijeysundera), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Knudtson), University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Austin, Ko, Wijeysundera), University of Toronto, Toronto, Ont.
Maria C BennellDivision of Cardiology (Kang, Bennell, Ko, Wijeysundera), Sunnybrook Health Sciences Centre, Schulich Heart Centre, University of Toronto; Institute for Clinical Evaluative Sciences (Qiu, Austin, Ko, Wijeysundera), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Knudtson), University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Austin, Ko, Wijeysundera), University of Toronto, Toronto, Ont.
Feng QiuDivision of Cardiology (Kang, Bennell, Ko, Wijeysundera), Sunnybrook Health Sciences Centre, Schulich Heart Centre, University of Toronto; Institute for Clinical Evaluative Sciences (Qiu, Austin, Ko, Wijeysundera), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Knudtson), University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Austin, Ko, Wijeysundera), University of Toronto, Toronto, Ont.
Merril L KnudtsonDivision of Cardiology (Kang, Bennell, Ko, Wijeysundera), Sunnybrook Health Sciences Centre, Schulich Heart Centre, University of Toronto; Institute for Clinical Evaluative Sciences (Qiu, Austin, Ko, Wijeysundera), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Knudtson), University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Austin, Ko, Wijeysundera), University of Toronto, Toronto, Ont.
Peter C AustinDivision of Cardiology (Kang, Bennell, Ko, Wijeysundera), Sunnybrook Health Sciences Centre, Schulich Heart Centre, University of Toronto; Institute for Clinical Evaluative Sciences (Qiu, Austin, Ko, Wijeysundera), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Knudtson), University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Austin, Ko, Wijeysundera), University of Toronto, Toronto, Ont.
Dennis T KoDivision of Cardiology (Kang, Bennell, Ko, Wijeysundera), Sunnybrook Health Sciences Centre, Schulich Heart Centre, University of Toronto; Institute for Clinical Evaluative Sciences (Qiu, Austin, Ko, Wijeysundera), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Knudtson), University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Austin, Ko, Wijeysundera), University of Toronto, Toronto, Ont.
Harindra C WijeysunderaDivision of Cardiology (Kang, Bennell, Ko, Wijeysundera), Sunnybrook Health Sciences Centre, Schulich Heart Centre, University of Toronto; Institute for Clinical Evaluative Sciences (Qiu, Austin, Ko, Wijeysundera), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Knudtson), University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Austin, Ko, Wijeysundera), University of Toronto, Toronto, Ont.
Sunnybrook Health Science Centre · CAHealth Sciences Centre · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCardiovascular disease is costly, and annual expenditures are projected to increase. Our objective was to examine the variation in patient-level costs and identify drivers of cost in patients with stable coronary artery disease.

methodsIn this retrospective cohort study using administrative databases in Ontario, Canada, we identified all patients with stable coronary artery disease after index angiography between Oct. 1, 2008, and Sept. 30, 2011. We excluded patients with a myocardial infarction within 90 days before the index, with normal coronaries, or with mild coronary disease. We categorized hospitals into low, medium or high revascularization ratio centres. The primary outcome was cumulative 1-year health care costs. A hierarchical generalized linear model identified patient, physician and hospital characteristics associated with patient costs, with 2 main covariates of interest: treatment allocation (medical v. percutaneous coronary intervention v. coronary artery bypass grafting) and hospital revascularization ratio.

resultsA total of 183 630 angiography procedures were performed in Ontario during the study period. The final cohort included 39 126 patients with stable coronary artery disease, of which 15 138 received medical treatment and 23 988 received revascularization. The mean 1-year cost was $24 026 (interquartile range $8235-$30 511). The mean costs for medical management and revascularization were $18 069 and $27 786, respectively. The strongest predictor of costs was revascularization (percutaneous coronary intervention: cost ratio 1.27, 95% CI [confidence interval] 1.24-1.31; coronary artery bypass grafting: cost ratio 2.62, 95% CI 2.53-2.71). Hospital revascularization ratio did not significantly affect costs. There was no significant interaction between treatment and revascularization ratio.

interpretationMost health care costs were due to acute care hospital admissions, and costs were higher for patients undergoing revascularization than medical therapy. This study suggests that treatment decision has a substantial impact on health care resources.

Identifiers

PMID27730104
PMCPMC5047799
OpenAlexW2500073657

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.