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The Impact of Advanced Medical Devices and Procedures on Cardiovascular Disease

The Impact of Advanced Medical Devices and Procedures on Cardiovascular Disease. Darryl Powell Mentor: Peter Groeneveld, MD MS LDI SUMR 2008. Drug-Eluting Stents. Drug-Eluting Stents (DES) are stents that contain pharmaceuticals that help to prevent the artery from becoming blocked again.

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The Impact of Advanced Medical Devices and Procedures on Cardiovascular Disease

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  1. The Impact of Advanced Medical Devices and Procedures on Cardiovascular Disease Darryl Powell Mentor: Peter Groeneveld, MD MS LDI SUMR 2008

  2. Drug-Eluting Stents • Drug-Eluting Stents (DES) are stents that contain pharmaceuticals that help to prevent the artery from becoming blocked again. • DES drives the cost of receiving a stent up from $600 to $1800. • DES are used in 66% of all US cases of coronary artery blockage totaling 1.3 million procedures per year resulting in a health care cost increase of $5 billion.

  3. Value of Technology • The assessment of the value of technology is two-fold: Does it extend life? Does it increase quality of life?

  4. Does it Extend Life? • DES do not reduce mortality or the rate of acute myocardial infarction. • Clinical trials have found that the sole benefit of DES is the reduction of restenosis (recurrence of the blockage) and target vessel revascularizations (the need to repair the same artery).

  5. Does it increase QOL? • We are currently conducting face-to-face interviews with patients who have undergone coronary stent implantation the day after their procedure. • We hope to gain an understanding of the patients’ impressions of the procedure.

  6. Methods • The names of patients who received a coronary stent are obtained. • After the patient is consented, we administer the survey in the patient’s room. • Patients are given a $25 Visa Gift Card for their time.

  7. Our Hypothesis • As the procedure is minimally invasive, we expect that revascularizations result in a very small, transient decrease in quality of life. • If this is the case, then DES will have a minimal effect on the future quality of life of a patient and no effect on the duration of life. • Therefore DES would not be considered cost-effective with very little return on a large investment

  8. Survey Instrument • Demographics • Charlson Co-Morbidity Index • Coronary Stent QOL Assessment • Seattle Angina Questionnaire • SF-12 • EuroQoL

  9. Research In Progress • So far 12 surveys have been completed and we have a target of 100. • Male= 9 • Female= 3 • Median Age= 59 • Patients all seem to have extremely positive impressions of the procedure often indicating a willingness to have it done again.

  10. Policy Implications • As the rate of the implementation of new technologies continues to increase they will be held to a greater degree of scrutiny by insurers, employers, and taxpayers resulting in narrower coverage guidelines. (ex. UK decision concerning DES coverage guidelines.)

  11. What I Learned? • Patient Interaction Skills • Communication Skills • Administering Surveys • Assessing the Value of Technology

  12. Acknowledgements • Peter Groeneveld, MD MS • Christine Camacho • Joanne Levy and the SUMR Staff • Fellow SUMR Scholars • Leonard Davis Institute for Health Economics • Penn School of Medicine

  13. Acknowledgements Cont… • The University of Pennsylvania Provost’s Diversity Fund • The Center for Health Equity Research and Promotion (CHERP) • Pennsylvania Department of HealthOffice of Health Equity

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