Transcript Slide 1

CARDIOVASCULAR INPATIENT TRENDS
April 2010
DATA SOURCE: THOMSON REUTERS MARKETSCAN® HOSPITAL DRUG DATABASE
YOUR USE OF THESE MATERIALS IS SUBJECT TO THE TERMS AND CONDITIONS HEREOF. PLEASE READ THE
DISCLAIMER CAREFULLY BEFORE USING THESE MATERIALS.
CARDIOVASCULAR INPATIENT TRENDS
Q42005 – Q42009
• Executive summary
• Cardiovascular admissions
– Surgical and medically-managed
– Stents
– Atrial fibrillation
– Percutaneous intervention
• Reference section
– All hospital admissions trends
– Notes
©2010 Thomson Reuters
– About the data
– Contact us
– Terms of use and disclaimer
CARDIOVASCULAR ADMISSIONS
Q42005 – Q42009 EXECUTIVE SUMMARY
• Cardiovascular admissions rose 5.9% from 2005 to 2009;
however, growth rates are not even year to year.
• Medically-managed admissions show greater seasonal
volatility and a slightly faster growth rate than cardiovascular
surgical patients.
• The volume of urgent surgical admissions exceeded nonurgent admissions in the first quarter of 2008 and continued
to increase in market share throughout 2009.
• Total admissions with a coronary stent have been declining
since Q2 2008.
©2010 Thomson Reuters
• Drug-eluting stents represented 90% of all coronary stents in
Q2 2006, fell into a trough of 65% in 2008, and have since
rebounded to 74.6% of admissions in 2009 – 74.6% of a
shrinking market.
• The Q1 2009 volume for percutaneous interventions was
unusually low compared to prior years.
UPWARD TREND IN CARDIOVASCULAR
ADMISSIONS
• Despite dropping admissions for AMI and heart failure, total admissions with
a cardiovascular diagnosis rose 5.9 % from 2005-2009 due to an increasing
number of patients with cardiovascular diagnosis as a secondary condition.
This is contributing to the overall increase in severity of admissions.
• While cardiovascular admissions have demonstrated a traditional seasonal
peak in Q1, 2009 did not exhibit this peak.
Total Cardiovascular Admissions
3,500,000
Number of Admissions
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
©2010 Thomson Reuters
0
Q1
Q2
Q3
2005
Q4
Q1
Q2
Q3
2006
Q4
Q1
Q2
Q3
2007
Q4
Q1
Q2
Q3
2008
Q4
Q1
Q2
Q3
Q4
2009
Source: Thomson Reuters MarketScan® Hospital Drug Database. Cardiovascular medically-managed admissions were identified using diagnosis codes 390.xx-xx - 459.xx.
Surgical admissions were identified by the presence of diagnosis code of 390.xx-xx - 459.xx and a procedure code of 35.xx- 39.99.
MEDICALLY-MANAGED CARDIOVASCULAR
ADMISSIONS
• The compound annual growth rate for medically-managed admissions was 7.0%.
• Surgical admissions grew 5.1% despite continued decreases in the CABG market.
• Surgical and medically-managed cardiovascular admissions maintained their
relative market share.
Surgical
Admissions
Cardiovascular Admissions
Number of Admissions
2,000,000
1,500,000
Medically Managed
Admissions
1,000,000
500,000
0
©2010 Thomson Reuters
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2005
2006
2007
2008
2009
Source: Thomson Reuters MarketScan® Hospital Drug Database. Cardiovascular medically-managed admissions were identified using diagnosis codes 390.xx-xx - 459.xx.
Surgical admissions were identified by the presence of diagnosis code of 390.xx-xx - 459.xx and a procedure code of 35.xx- 39.99.
URGENT VERSUS NON-URGENT
CARDIOVASCULAR SURGICAL ADMISSIONS
• While the proportion of inpatient cardiovascular admissions coming through
the emergency room has been climbing since 2005, there appears to be a
minor downturn in late 2009.
1,000,000
Number of Admissions
Urgent
Admissions
Cardiovascular Surgical Admissions
Non-urgent
Admissions
750,000
500,000
©2010 Thomson Reuters
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2005
2006
2007
2008
2009
Source: Thomson Reuters MarketScan® Hospital Drug Database. Urgent admissions are admissions through the emergency room. Surgical admissions were
identified by the presence of diagnosis code of 390.xx-xx - 459.xx and a procedure code of 35.xx- 39.99.
DRUG ELUTING VERSUS
BARE METAL STENTS
• Coronary stent use has declined 17.9% since Q2 2008, with drug-eluting
stents capturing 74.6% of a shrinking market in Q4 2009.
Admissions By Type of Coronary Stent
180,000
Number of Admissions
160,000
140,000
Bare Metal
Stents
120,000
100,000
80,000
Drug Eluting
Stents
60,000
40,000
20,000
0
©2010 Thomson Reuters
Q1
Q2
Q3
2005
Q4
Q1
Q2
Q3
2006
Q4
Q1
Q2
Q3
2007
Q4
Q1
Q2
Q3
2008
Q4
Q1
Q2
Q3
Q4
2009
Source: Thomson Reuters MarketScan® Hospital Drug Database. Coronary drug eluting stents were identified using procedure code 36.07; coronary bare
metal stents were identified using procedure code 36.06.
ATRIAL FIBRILLATION & FLUTTER
• From 2005 to 2007 atrial fibrillation and atrial flutter admissions increased by
3.4%. From 2007 through 2009, admissions decreased by 2.7%.
• This is related to an overall change in the rate of cardiac surgeries and may
have a relationship to more aggressive monitoring of patients.
Total Admissions with Atrial Fibrillation or Flutter
1,000,000
Admissions
800,000
841,825
873,150
898,836
859,261
853,855
600,000
400,000
200,000
0
©2010 Thomson Reuters
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2005
2006
2007
2008
2009
Source: Thomson Reuters MarketScan® Hospital Drug Database. Atrial Fibrillation and Flutter were identified using diagnosis codes 427.31 and 427.32.
PERCUTANEOUS INTERVENTION (PCI)
• The volume of inpatient PCIs shows a sharp decline over the most recent 18
months (since Q2 2008).
• This is related to the overall decrease in the stent market.
Total PCI Admissions
200,000
Admissions
150,000
100,000
50,000
©2010 Thomson Reuters
0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2005
2006
2007
2008
2009
Source: Thomson Reuters MarketScan® Hospital Drug Database. PCI admissions were identified using procedure codes 00.66, 36.06, and 36.07.
PERCUTANEOUS INTERVENTION (PCI)
• While the overall PCI market is flat, the mix of urgent and non-urgent admissions
continues to change as urgent admissions increased by 5.5% between 2005 and 2009.
–
In Q4 2005, urgent admissions represented 36% of PCI admissions. In Q4 2009, they were 42% of
admissions.
• Non-urgent PCI admissions have declined by 5.1% between 2005 and 2009. In Q4 2009,
this represented 58% of PCI admissions.
Urgent versus Non-urgent PCI Admissions
120,000
Non-urgent
Admissions
Number of Admissions
100,000
80,000
60,000
40,000
Urgent
Admissions
20,000
0
©2010 Thomson Reuters
Q1
Q2
Q3
2005
Q4
Q1 Q2
Q3
2006
Q4
Q1
Q2 Q3
2007
Q4
Q1
Q2
Q3 Q4
2008
Q1
Q2
Q3
Q4
2009
Source: Thomson Reuters MarketScan® Hospital Drug Database. PCI admissions were identified using procedure codes 00.66, 36.06, and 36.07.
REFERENCE SECTION
ALL HOSPITAL ADMISSIONS
• The overall trend in total hospital admissions continues to be flat.
Total Admissions
5,000,000
All other payers
Number of Admissions
4,000,000
Commercial
3,000,000
Medicare
2,000,000
1,000,000
©2010 Thomson Reuters
0
Q1 Q2 Q3
2005
Q4
Q1 Q2
Q3
2006
Q4 Q1 Q2
Q3
2007
Q4 Q1 Q2
Q3
2008
Source: Thomson Reuters MarketScan® Hospital Drug Database.
Q4
Q1 Q2 Q3
2009
Q4
©2010 Thomson Reuters
NOTES
•
All growth rates are Compound Annual Growth Rate calculated as:
CAGR = (V2009 / V2005)1/5 – 1
•
All other payers is defined as admissions that are not paid for by Medicare
or Commercial insurers
ABOUT THE DATA
• Data represent projected estimates for the total U.S. market based on data
from the Thomson Reuters MarketScan® Hospital Drug Database.
• The Hospital Drug Database provides monthly projections of national and
regional inpatient diagnosis, procedure, and pharmaceutical volumes.
Projections are based on a non-random sample of hospitals that submit near
real-time discharge and pharmaceutical information to the Hospital Drug
Database.
©2010 Thomson Reuters
• To create valid national projections from this sample, Thomson Reuters
develops factors that account for case-mix differences among hospitals and
projects these to the Healthcare Cost and Utilization Project (HCUP)
Nationwide Inpatient Sample. These projection weights indicate the number
of similar patients each sample discharge represents in the nationwidesample universe. The weights are assigned to each discharge record in the
Hospital Drug Database and are applied identically to all medication records
associated with the discharge record.
• The Hospital Drug Database is derived primarily from hospital billing systems
from over 590 hospitals. This database provides the most detailed and
comprehensive data available for understanding hospital care, including drug
utilization in the hospital setting. The database includes 46.5 million hospital
discharges between January 2002 and January 2010. Data are updated
monthly, 45-days after the close of the month.
FOR MORE INFORMATION
• For more information about these reports or to inquire about more detailed
hospital reporting, please contact:
– Pharmaceutical Research and Analytics
– +1 866-301-5419
©2010 Thomson Reuters
– [email protected]
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