Abstract 6225: Cost of Improvement of Angina-Related Health Status by Health Care System: A Secondary Analysis from the COURAGE Trial
Bibliographic record
Abstract
Background: COURAGE compared percutaneous coronary intervention (PCI) plus intensive pharmacologic and lifestyle intervention (optimal medical therapy, OMT) to OMT alone in reducing the risk of cardiovascular events in patients with stable coronary disease. In this post hoc study, we assessed the cost of treating angina across the three health care systems from which patients were enrolled: Canada, US non-Veterans Affairs (VA) and U.S. VA. Methods: A total of 2,287 patients were enrolled and followed for a median of 4.6 years. Angina-related health status was assessed with the Seattle Angina Questionnaire (SAQ) and RAND-36. The cost of resource use was evaluated by DRG for hospitalizations and CPT for outpatient visits and tests. Analyses were conducted using the U.S. non-VA costing system in 2004 U.S. dollars. Clinically significant differences in the Physical Limitation, Angina Frequency, and Quality of Life domains of the SAQ were defined as scores ≥8, ≥20, and ≥16 respectively. Absolute net benefit, number of patients needed to treat (NNT) to achieve one patient with clinically significant angina improvement, and the cost of improvement in angina-related health status were estimated. Results: Added cost of PCI per patient and results for Angina Frequency are presented in the table . Results for Quality of Life were similar. Physical Limitation results varied more widely among health care systems with net benefit ranging from <1% (U.S. non-VA) to 18% (Canada), and cost per patient in angina improvement from $55,700 (Canada) to over $1,000,000 (U.S. non-VA). Conclusions: The improvement of angina-related health status and corresponding costs were relatively similar across health care systems and among SAQ Angina Frequency and Quality of Life domains, but varied widely for the Physical Limitation Domain. Adding PCI to OMT improved angina-related health status, but at a cost generally considered to be prohibitive as a routine initial management strategy. Cost of Improvement of Angina-Related Health Status by Health Care System
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".