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Biomedical subjects

Joseph Thomas

Publications and source records attributed to Joseph Thomas.

18 recordsLinked to original sources
PubMed2006

Survey of pharmacist collaborative drug therapy management in hospitals.

PURPOSE: The extent and scope of collaborative drug therapy management (CDTM) in U.S. hospitals and pharmacy directors' perceptions regarding CDTM were studied. METHODS: A survey was developed after reviewing the literature on CDTM. The sample for the study was obtained from the 2001 American Hospital Association Guide. The mail survey was pretested in January 2002 with 30 hospital pharmacy directors in Illinois, Indiana, and Michigan. A national random sample of 1000 hospital pharmacy directors stratified by state were mailed surveys in March 2003. Two follow-up surveys were mailed at approximately four-week intervals. RESULTS: Responses were received from 327 hospitals, a 32.7% response rate. A total of 158 respondents (49.7%) indicated that some pharmacists in their hospital were engaged in CDTM. Most hospitals with CDTM authorized pharmacists to adjust a drug's strength (86.7%), order laboratory or related tests (84.2%), and change a drug's frequency of administration (81.6%). The CDTM-related activities pharmacists performed varied with disease and treatment area. Payment or reimbursement for some CDTM was received by 12.7% of hospitals with CDTM. Respondents from hospitals with CDTM perceived significantly greater support for CDTM and greater strategic impact of CDTM than those from hospitals without CDTM. Respondents perceived positive support for CDTM but believed that CDTM had little or no financial impact on pharmacy departments. CONCLUSION: Approximately 50% of respondent hospitals had some pharmacists engaged in CDTM. Although CDTM was perceived as not having a positive financial impact on pharmacy departments, it was perceived as having a positive strategic impact by improving the views of upper administration regarding the value of pharmacists and facilitating implementation of other pharmacy services.

Attitude of Health Personnel↗
PubMed2006

Relationships between beliefs about medications and nonadherence to prescribed chronic medications.

BACKGROUND: Medication beliefs of patients with a specific medical condition have been associated with nonadherence to drugs used to treat that condition. However, associations between medication beliefs and nonadherence of individuals on chronic, multiple medications have not been studied. OBJECTIVE: To investigate associations between patients' medication beliefs and nonadherence to chronic drug therapy. METHODS: A cross-sectional, self-administered survey of patients waiting to see pharmacists at an outpatient pharmacy in a primary care clinic was conducted. Participants' medication beliefs were assessed using the Beliefs about Medicines Questionnaire, and nonadherence was assessed using the Morisky Medication Adherence Scale. Pearson correlation analysis was used to assess bivariate associations between medication beliefs and nonadherence. Regression was used to assess relative strength of associations between various medication beliefs and nonadherence and also to assess the significance of the interactions between those beliefs and nonadherence. RESULTS: There were positive bivariate associations between specific concerns about medications (p < 0.001), perceived general harmful effects of medications (p < 0.001), and perceived overprescribing of medications by physicians (p < 0.001) and medication nonadherence. When relative strength of associations between each medication belief and nonadherence was assessed, while controlling for other medication beliefs, specific-necessity (p = 0.02) and specific-concerns (p = 0.01) exhibited significant negative and positive associations with nonadherence, respectively. All two-way interactions between variables in the model were insignificant. A model consisting of age, total number of drugs used, and medication beliefs, that is, specific-necessity, specific-concerns, general-overuse, and general-harm, accounted for 26.5% of variance. Medication beliefs alone explained 22.4% of variation in nonadherence to chronic drug therapy. CONCLUSIONS: Patients' medication beliefs explained a significant portion of variation in medication nonadherence.

Adult↗
PubMed2006

Incremental expenditure of treating hypertension in the United States.

BACKGROUND: This study determined incremental direct expenditures of treating hypertension in the United States population. METHODS: Analysis of the 2001 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the civilian noninstitutionalized U.S. population, was conducted. Hypertensive patients were identified as those with a medical diagnosis for hypertension based on International Classification of Diseases (ICD)-9 codes; patients who were consumers of hypertension-related medical care services including inpatient and outpatient visits, emergency room visits, home health visits, office-based medical provider visits, and other medical expenses; patients who self-reported being diagnosed with hypertension by their physicians; and patients who were prescribed antihypertensive medication. Incremental expenditure of treating hypertension was estimated through least-squares regression adjusting for age, sex, ethnicity, education, and comorbidities using the D'Hoore et al version of the Charlson comorbidity index. Sample data were projected to the U.S. population and 95% confidence limits for estimates were calculated using the Taylor expansion method. RESULTS: Sample estimates projected to the population indicated that approximately 17.4% of individuals >or=18 years of age in the ambulatory population have hypertension. Total incremental annual direct expenditures for hypertension patients were estimated to be more than 54.0 billion US dollars in 2001 after adjusting for demographics and comorbidities. Mean incremental annual direct expenditures for an individual with hypertension was 1,131 US dollars . Prescription medicines, inpatient visits, and outpatient visits constituted >90% of overall incremental expenditures. CONCLUSIONS: With incremental direct medical expenditures estimated at nearly 55.0 billion US dollars, hypertension expenditures represent a significant amount of health care resource use.

Adolescent↗
PubMed2006

Hydroxyurea induced perimalleolar ulcers.

Hydroxyurea (HU) is an antineoplastic drug commonly used to treat chronic myeloproliferative disorders. Common dermatological side effects include hyperpigmentation, scaling, erythema, alopecia, desquamation of face and hands. Leg ulceration following HU therapy is less common and very few cases have been reported so far. Objective of this paper is to increase the awareness of hydroxyurea induced leg ulcers which will aid in the early diagnosis and appropriate treatment. The first case was a chronic myeloid leukemia (CML) patient on HU 1.5 g/day for 5 yr, who had bilateral painful perimalleolar ulcers for 6 months. The second case was a CML patient on HU 1.5 g/day for 3 yr who developed bilateral lateral malleolar ulcers. Third case was a polycythemia vera (PV) patient on HU 1 g/day for 5 yr who presented with painful medial malleolar ulcer of 2 months. The last case of our report was an elderly PV patient on HU 1.5 g/day for 2 yr and presented with lateral malleolar ulcer which persisted on reducing the dose of HU. In all the 4 cases the ulcers healed on stopping HU. Our report confirms the association of chronic hydroxyurea therapy and perimalleolar ulcers which respond promptly after discontinuation of the drug. The heightened awareness among the physicians will promote early diagnosis and prompt relief from the agonizing ulcers.

Aged↗
PubMed2006

Corneal light backscatter measured by optical coherence tomography after LASIK.

PURPOSE: To objectively quantify corneal light backscatter after LASIK using optical coherence tomography (OCT). METHODS: Twenty-eight eyes of 14 patients (mean age: 39.9 +/- 8.6 years) underwent LASIK surgery. Corneal images were taken with a custom built anterior segment OCT at 1310 nm before and 1 day, 1 week, and 1 month after surgery. Backscattered light from the epithelium and 10 equally divided corneal stromal layers of the central cornea were analyzed using custom software. Light scattering of the interface area (defined as seven image pixels [46.2 microm] in depth centered by the peak corresponding to the interface between the corneal flap and bed) was also calculated and compared to the light backscatter at an equivalent depth of the respective preoperative cornea. RESULTS: There were significant differences of light backscatter in different layers (analysis of variance [ANOVA]: F(10, 130) = 44.89, P = .0001), but no significant differences between right and left eyes preoperatively (ANOVA: F(10, 130) = 1.16, P = .32). After surgery, there were significant differences in light backscatter profiles of the central cornea (repeated measures ANOVA: F(30, 810) = 7.70, P = .0001) with significant increases at approximately 140 to 190 microm in depth from the corneal front surface at 1 day (post hoc test: P = .004) and 1 week (post hoc test: P = .001) postoperatively, compared to the baseline. One month after surgery, light backscatter increased significantly in the epithelium (post hoc test: P = .0001) and decreased significantly (post hoc test: P = .0001) at approximately 100 to 140 microm in depth. Light backscatter results of these interface areas (repeated measures ANOVA: F(3, 81) = 21.29, P = .0001) showed significant increases at 1 day and 1 week postoperatively (post hoc tests: P = .0001) compared to baseline results and 1-month postoperative results. CONCLUSIONS: Objective and quantitative analysis of corneal light backscatter from OCT demonstrated increasing comeal light scattering at the interface and subsequent recovery.

Adult↗
PubMed2006

Comparison of corneal thickness measured with optical coherence tomography, ultrasonic pachymetry, and a scanning slit method.

PURPOSE: To investigate the relationship between 1310-nm optical coherence tomography (OCT), an ultrasound pachymeter, and the Orbscan II (Bausch & Lomb, Rochester, NY) in corneal thickness measurements before and after LASIK. METHODS: Twenty-eight eyes of 14 patients with a mean age of 39.9 +/- 8.6 years underwent LASIK for correction of myopia with or without astigmatism. Central corneal thickness was measured with real-time 1310-nm OCT and Orbscan preoperatively and 1 day, 1 week, and 1 month postoperatively, and with an ultrasound pachymeter preoperatively and 1 month postoperatively. RESULTS: Measurements of corneal thickness by all instruments correlated well with one another pre- and postoperatively (r value range: 0.87 to 0.94, P<.05); however, there were significant differences among these methods (ANOVA: P<.005). Baseline readings for ultrasound and Orbscan were similar, as were readings 1 month postoperatively for OCT and Orbscan (P>.05). Thickness measured by OCT was thinner than for other instruments preoperatively (P<.005) and thicker than Orbscan postoperatively (P<.005). Significant corneal thinning (P<.001) was found with all study devices 1 day after laser ablation. Significant corneal thinning (P<.005) was found with OCT and Orbscan 1 week compared to 1 day postoperatively, and thickening (post hoc: P<.001) was evident at 1 month compared to 1 week postoperatively. CONCLUSIONS: Although the instruments correlated well in measuring corneal thickness after LASIK, there were significant differences. All instruments indicated corneal swelling and recovery during the first postoperative week and thickening at 1 month.

Adult↗
PubMed2005

Nature and correlates of SF-12 physical and mental quality of life components among low-income HIV adults using an HIV service center.

OBJECTIVES: This study describes health-related quality of life (HRQOL) among low-income HIV adults using an HIV service center, compares participants' scores to US published norms for the general population and persons with chronic conditions, and examines relationships between patient characteristics, nonadherence, and HRQOL. METHODS: A cross-sectional survey of individuals on antiretroviral therapy was conducted. The Medical Outcomes Study SF-12 was used to assess HRQOL. Medication nonadherence was assessed using the 9-item Morisky Adherence Scale. Data also were collected on social support, CD4 cell count, and time since diagnosis. RESULTS: Approximately 84% of the 86 participants were male, 50% were white, and 39% were black. The mean +/- SD Physical component summary (PCS-12) score of 41.0 +/- 12.5 and Mental component summary (MCS-12) score of 41.9 +/- 11.0 were lower than US general population norms (p < 0.001). PCS-12 scores were similar to those of patients with other chronic conditions. Respondents reported lower MCS-12 scores than patients with hypertension and diabetes (p < 0.006). Employment and higher social support had positive associations with PCS-12 scores and nonadherence had a negative association with MCS-12 scores (p < 0.05). CONCLUSIONS: HRQOL in this sample of low-income HIV adults was comparable to other HIV populations. Identifying strategies for increasing social support and medication adherence for economically disadvantaged persons with HIV/ AIDS may improve their HRQOL.

Adolescent↗
PubMed2005

Prevalence and correlates of potentially inappropriate prescribing among ambulatory older patients in the year 2001: comparison of three explicit criteria.

OBJECTIVES: The aims of this study were to determine the prevalence of prescribing potentially inappropriate medications (PIMs) based on the 2002 Beers criteria among ambulatory patients aged > or =65 years, to compare PIM prevalence rates based on the 1997 Beers criteria and Zhan criteria with the rate obtained using the 2002 Beers criteria, and to examine patient, provider, and visit characteristics associated with receiving a PIM. METHODS: Retrospective analysis was conducted of the year-2001 public-use data files of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. The 2002 Beers criteria 1997 Beers criteria, and Zhan criteria were used to determine presence of PIMs. Multivariate logistic regression was performed to identify patient, visit, and provider characteristics associated with receiving a PIM. RESULTS: A total of 7243 ambulatory visits by individuals aged > or =65 years with > or =1 prescription were projected to an estimated 157 million such ambulatory visits. An estimated 21 million visits (13.4%) involved PIMs based on the 2002 Beers criteria, compared with 13.9 million visits (8.8%) based on the 1997 Beers criteria and 6.6 million visits (4.2%) based on the Zhan criteria. An additional 7.2 million visits (4.6%) by eligible patients involved medications defined by the Zhan criteria as having some indications but often being misused. After adjusting for other factors, visits made in metropolitan areas (odds ratio [OR], 2.42 195% Cl, 1.14-5.12) or by referred patients (OR, 2.28 195% CI, 1.43-3.61) were more likely to involve a PIM. Compared with visits involving 1 medication, those involving 2 (OR, 2.39 [95% CI, 1.30-4.41]), 3 (OR, 7.01 [95% Cl, 3.42-14.35]), or > or =4 medications (OR, 7.35 [95% Cl, 4.44-12.17]) were more likely to be associated with a PIM. CONCLUSIONS: Prevalence of PIMs among ambulatory patients aged > or =65 years is high. The most frequently prescribed PIMs and positive risk factors warrant greater attention from a policy perspective.

Aged↗
PubMed2005

Evaluation of an antiretroviral medication attitude scale and relationships between medication attitudes and medication nonadherence.

The objectives of this study were to refine a scale designed to assess attitudes toward antiretroviral medication, to examine variation in medication attitudes across clinical and demographic characteristics, and to assess relationships between medication attitudes and medication nonadherence. A cross-sectional design was used to survey individuals at least 18 years of age, currently on antiretroviral therapy, and served by a regional HIV/AIDS center. The survey was administered by pharmacy students using convenience sampling between February 2002 and August 2002. Nonadherence was measured using a nine-item scale with a higher score indicative of higher nonadherence. An antiretroviral medication attitude scale was developed based on revision of a zidovudine attitude inventory. The sample of 99 patients was predominantly male (79.8%), had an annual income of less than $10,000 (74%), and was comprised of 50% whites and 40.8% blacks. Participants were between 18 and 70 years old. Item reduction using item-total correlations and factor analytic techniques resulted in a 15-item medication attitude scale with good internal consistency (Cronbach alpha coefficient = 0.84). A multiple regression model showed a significant negative relationship between attitude toward medication and medication nonadherence after controlling for covariates including age, education, gender, ethnicity, work status, social support, CD4 cell count and number of antiretroviral medications, suggesting that more positive the attitude toward medication, lower the medication nonadherence. Findings underscore the importance of attitude toward medication as a modifiable factor that can be targeted to improve medication adherence.

Adolescent↗
PubMed2005

Health insurance coverage and health-related quality of life: analysis of 2000 Medical Expenditure Panel Survey data.

This study investigated relationships between health insurance status and health-related quality of life (HRQOL) using the 2000 Medical Expenditure Panel Survey data. Health-related quality of life was measured using the SF-12 Physical Component Summary (PCS) and SF-12 Mental Component Summary (MCS). The analysis controlled for sociodemographic and attitudinal variables and medical conditions. The analysis also investigated and controlled for possible reverse causality between HRQOL and health insurance in the models. After adjusting for covariates, individuals without health insurance had significantly lower mean PCS scores (beta=-5.8; SE=0.4) than those with health insurance. The adjusted association between no health insurance and MCS scores (beta=-1.1; SE=0.4) also was significant. The adjusted difference in HRQOL among people with health insurance and those without it exceeds or is comparable to adjusted differences in HRQOL between people with each of various medical conditions and people without them.

Adult↗
PubMed2004

Noncontact measurements of central corneal epithelial and flap thickness after laser in situ keratomileusis.

PURPOSE: To investigate the changes in the epithelium and flap after laser in situ keratomileusis (LASIK), when measured with optical coherence tomography (OCT). METHODS: Twenty-eight eyes of 14 patients (age: 39.9 +/- 8.6 years) underwent LASIK. The central thickness of corneal epithelium and flap were measured with a real-time 1310 nm OCT 1 day, 1 week, and 1 month after surgery. A custom software program was used to process multiple images of each eye on each visit. RESULTS: After surgery, the corneal epithelium changed significantly (ANOVA: F((3, 81)) = 12.3, P = 0.000) with not statistically significant thinning at one day (mean +/- SD: 57.8 +/- 5.9 micro m, P = 0.26, compared with baseline: 59.9 +/- 5.9 micro m) and statistically significant thickening at 1 week (60.8 +/- 5.8 micro m, P = 0.04, compared with 1 day) and 1 month (64.6 +/- 6.1 micro m, P = 0.008 compared with all others). There were statistically significant changes in the corneal flap thickness (ANOVA: F((2, 54)) = 4.59, P = 0.01) with thickening in the intervals between 1 day (143.3 +/- 20.6 micro m) and 1 week (149.7 +/- 24.6 micro m, P = 0.12), and between 1 week and 1 month (152.7 +/- 19.3 micro m, P = 0.01). There was a strong correlation (r = 0.898) between the difference of corneal thickness before and after surgery and predicted laser ablation depth. CONCLUSIONS: OCT is a useful noncontact tool for thickness measurements of the epithelium, flap, and total cornea. After LASIK, the epithelium and flap showed thickening during the study period.

Adult↗
PubMed2004

Variations in pediatric asthma hospitalization rates and costs between and within Nordic countries.

BACKGROUND: We assessed variations in hospitalization parameters and costs among asthmatic children in four Nordic countries by geographic location and age groups. METHODS: Cross-sectional, county-level aggregate data on asthma-related hospitalizations in 1999, obtained from public national databases for children < 15 years old from Denmark, Sweden, Norway, and Finland, together with country-specific asthma management cost were used to estimate the incidence of first hospital admission (per 1,000), length of hospital stay (LOS), and hospitalization cost. Longitudinal patient-specific data from 1998/1999 were used to calculate the relative hazard of readmission (RHR) using a multivariate Cox proportional hazards model. RESULTS: Nordic incidence of first hospital admission in 1999 was 2.17 per 1,000 children, readmission was noted in 16% of the patients, mean LOS was 2.64 days, and total hospitalization cost was almost 14 million dollars. Hospitalization incidence, RHR, and costs were significantly higher in children < 5 years old compared with school children 6 to 14 years old. Hospital LOS, incidence of first hospital admission, and cost per child were the highest in Denmark, though RHR did not differ significantly from Sweden. CONCLUSIONS: Large variations in all parameters were observed between and within countries. Given the similarities among the four countries studied, these results may, among other reasons, indicate different efficiencies of the various asthma management plans between and within them. The presented measures of hospitalization patterns could prove to be valuable quality-of-care measures to guide further improvements in asthma management.

Adolescent↗
PubMed2002

Over-the-counter nonsteroidal anti-inflammatory drugs and risk of gastrointestinal symptoms.

OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications. Although much is known about prescription NSAIDs and risk of GI side effects, little is known about over-the-counter (OTC) NSAIDs and their risk of GI side effects. The aim of this study was to estimate use of OTC NSAIDs, GI side effects, and professional and self-care for these side effects. METHODS: We conducted a telephone survey of an age-stratified U.S. random sample of 535 persons at least 40 yr old, who used an OTC NSAID for 4 of the previous 7 days, and a matched comparison population of 1068 persons who used no NSAID within the previous 30 days. We measured current use of OTC NSAIDs, GI symptoms, diagnoses and their treatment, and prescription and OTC GI medications. RESULTS: The most commonly used OTC NSAID was aspirin (alone or in combination compounds). Prevention of myocardial infarction or stroke was the most common reason for use (43.2%), followed by all forms of pain relief (44.2%) and relief of arthritis symptoms (24.5%). NSAID users were twice as likely as nonusers to report GI side effects (19.6% vs 9.5%, p = 0.0001), and more than twice as likely to use an OTC GI medication when they had GI symptoms (46.7% vs 20.8%, p = 0.001). CONCLUSIONS: OTC NSAIDs are not a benign medication even at low dosages. Physicians may be unaware that patients self-medicate with OTC NSAIDs and for GI side effects with additional OTC GI medications. Therefore, physicians should routinely ask patients about all forms of self-treatment.

Adult↗
PubMedDate not supplied

Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population.

OBJECTIVES: The EuroQol (EQ-5D) and SF-6D (derived from the SF-12) were compared to assess any ceiling effect in the EQ-5D and the SF-6D descriptive systems. In addition, the Physical Component Summary (PCS-12), the Mental Component Summary (MCS-12) and the EuroQol Visual Analog Scale (EQ-VAS) were compared on their discriminative ability to detect differences among individuals with different morbidities and sociodemographic characteristics. METHODS: Data from the 2000 Medical Expenditure Panel Survey were used for the analysis. A total of 11,248 individuals that were 18 years or older and had data on all the study variables were included in the analysis. RESULTS: A total of 5104 individuals (47%) reported no limitations on all of the EQ-5D dimensions and only 683 (5.8%) were classified in full health based on the SF-6D descriptive system. Approximately 49% of the respondents that reported no limitations on the EQ-5D reported feeling "tense or downhearted and low,""a little," (level 2) or "some" (level 3) of the time on SF-6D. PCS-12 scores and EQ-VAS scores among individuals reporting no limitations on the EQ-5D descriptive system were significantly lower for respondents reporting coronary heart disease, angina, diabetes, myocardial infarction, high blood pressure or joint pain compared with respondents that reported no medical condition. Effect sizes for medical conditions using the PCS-12 were larger than the effect sizes using the EQ-VAS. CONCLUSIONS: Unlike the EQ-5D descriptive system, the SF-6D descriptive system derived from the SF-12 does not seem to have a ceiling effect. Nevertheless, the SF-6D does not discriminate between individuals with different morbidities who report full health on the EQ-5D, as does the PCS-12 and the EQ-VAS.

Adolescent↗
PubMedDate not supplied

Progress of pharmacist collaborative practice: status of state laws and regulations and perceived impact of collaborative practice.

OBJECTIVES: To determine the current status and features of states' laws on pharmacist collaborative practice, barriers and facilitators to the passage of such laws, pharmacists' satisfaction with present regulations, and pharmacy leaders' perceptions regarding the impact of collaborative practice on pharmacist-physician relationships and on patients' perceptions of pharmacists. DESIGN: Cross-sectional survey. SETTING: United States. PARTICIPANTS: Executives of state pharmacy organizations and officers of state pharmacy boards. MAIN OUTCOME MEASURES: Presence and features of collaborative practice law, perceptions regarding effects of collaborative practice on pharmacist-physician relationships, and patients' perceptions of pharmacists. RESULTS: Of 48 states responding to the survey, 32 (66%) had existing pharmacist collaborative practice laws; 23 states (48%) allowed pharmacists to initiate and modify therapy, whereas 9 (19%) allowed only modification of therapy. Dependent collaborative practice was permitted in 31 states (65%). Most state laws applied to hospital, long-term care, and community settings. Five of the 32 states with pharmacist collaborative practice laws had made changes to broaden the provisions since the original laws were enacted. Nine states out of 16 that did not have collaborative practice laws indicated plans to pursue passage of such laws. Overall, collaborative practice was viewed as having a positive effect on pharmacist-physician relationships and a slightly positive effect on patients' perceptions of pharmacists. Respondents believed that pharmacists currently involved in collaborative practice were mostly satisfied with present laws, although some respondents mentioned the need for further revisions to the laws. CONCLUSION: Significant progress has been made in passing and implementing laws on pharmacist collaborative practice. As positive experience is gained, good opportunities exist to broaden current laws and increase pharmacists' involvement in collaborative practice.

Attitude of Health Personnel↗
PubMedDate not supplied

A one-year comparison of cost and outcomes of angioplasty in stent and nonstent patients.

Most studies on costs and outcomes of stent use in percutaneous transluminal coronary angioplasty (PTCA) have been limited to less than 1 year of follow-up, in-hospital costs, or regional samples. The objective of this study was to compare restenosis rates and all direct medical care costs during the 1-year period following stent PTCA and nonstent PTCA. A nationwide claims database covering 1.7 million lives was used to identify patients with PTCA during 1995 and no PTCA during the previous year. All costs and rate of restenotic events during the 1-year period following PTCA were examined. Symptomatic restenosis was defined as the occurrence of any of the following: repeat angioplasty, coronary artery bypass surgery (CABG), and myocardial infarction (MI). Stents were placed in 304 of 1367 identified patients. Both the rate of restenotic events (stent, 16.1%; no stent, 20.1%) and ischemic disease-related costs (stent, $9207; no stent, $10,498) were lower for patients with a stent during the follow-up period; however, the difference was not significant. Because of the higher cost of placing a stent during the initial procedure, patients with a stent had a significantly higher cost at the end of the 1-year period (stent, $49,245; stent, $40,683). Multivariate analyses further confirmed this finding. Thus, although restenotic events were lower for patients with stents by a nonsignificant margin, follow-up costs did not offset the higher cost of the initial stent placement.

Analysis of Variance↗