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New Study Finds Significantly Greater Costs Associated with Multi-Vessel Disease in Medicare Patients Compared to those with Single Vessel Disease following an Acute Myocardial Infarction
Results highlight need for new pathways and therapeutic strategies to manage costs and maintain quality of care for multi-vessel disease patients

King of Prussia, Pa. – 08 November 2018  Global biotherapeutics leader CSL Behring in collaboration with Health Analytics, a prominent health economics and outcomes research provider, announce important findings from a new study seeking to estimate the economic impact of multi-vessel disease (MVD) a prevalent, yet previously uncharacterized condition.

The poster – titled “Acute Myocardial Infarction with Multi-Vessel Disease: Relationship with Service Utilization and Cost of Care” was presented October 23rd at the 2018 American Academy of Managed Care Pharmacy Nexus. The study uncovered an unmet area of need for the sickest and most costly segment of patients and offers an important first step in identifying and adequately supporting these patients.  

Clinical research shows that MVD occurs in about 60% of patients with an acute myocardial infarction (AMI). While there is no ICD-10-CM diagnosis code to accurately identify MVD, in approximately 50% of these cases, it is possible to infer MVD from the interventional procedures received.  Acute Myocardial Infarction (MI) patients with MVD are at increased risk for subsequent major cardiovascular events including stroke, recurrent MI, heart failure and death [1,2,3].  This study demonstrated that patients treated for MVD had significantly higher healthcare services utilization and incurred substantially higher inpatient and outpatient/emergency costs compared to AMI patients with occlusion of a single cardiac vessel.  Inpatient hospital costs alone for MVD treated patients were almost $5,000 higher than for patients without MVD.

“This groundbreaking retrospective data analysis helps us to better identify these highest risk MI patients, “said Dr. Ryan Saadi, Vice President of Global Access, Pricing, Health Economics & Outcomes Research (HE&OR) for CSL Behring.  “This work further supports our promise to these patients and represents an important step in helping us to quantify the cost of care for MVD and ultimately helps us to develop better protocols and therapies for more effective outcomes.”

Dr. C. Michael Gibson, Chairman of the PERFUSE Study Group at Beth Israel Deaconess Medical Center and Co-Author commented, “The results of this study have implications for patients, payers and healthcare systems.  By defining the economic and clinical impact of MVD in this large patient population, we see an opportunity to meet a primary patient need while building a strong case for reconciling the difference between hospital costs and Centers for Medicare & Medicaid Services (CMS) payments. Ultimately, new care pathways, protocols and therapeutic strategies will be necessary to manage the cost and resource utilization of MI patients with MVD.”

Existing diagnosis or procedure codes do not accurately identify the number of patients with MVD. Of the greater than 125,000 Medicare records analyzed for patients with a prior MI, only 27% with concomitant MVD were identified.  Unfortunately, according to clinical research this represents only roughly half of the MVD patient population, and underscores the need for an explicit MVD ICD diagnosis code. Additionally, the creation of such a code would help to resolve differences in hospital costs and CMS payments, Though, MVD is a significant indicator of disease burden in MI patients, it has been underreported and poorly characterized in the literature, yet patients with MVD are sicker, are more likely to have had a prior MI, a higher incidence of lipid disorders, peripheral arterial disease, coronary heart disease, heart failure and shock. Additionally, they present substantial incremental burden to the healthcare system compared to patients with single vessel disease.

Dr. Susan Gabriel, Director, Global Access, Pricing, HE&OR for CSL Behring noted, “A significant research implication of this study is the precedent it has set for understanding and quantifying service utilization and costs when an existing ICD-10 code does not exist.  The well designed process of applying appropriate inclusion and exclusion criteria to Medicare FFS Standard Analytic Files enabled us to accurately evaluate and define treatment of a disease state even when the data were not readily available.  We believe this sophisticated new model will make a significant contribution to future administrative claims research.”

The study investigators included Christopher Young, PhD; Susan Gabriel, MS, PhD; Gail Berman, MD; Charles Ruetsch, PhD; and C. Michael Gibson, MS, MD.

Declaration of financial or other relationship: C. Michael Gibson has received research grant support and consultancy fees from CSL Behring, LLC.


1.  M, B.G.H., Treatment Strategies of NSEMI-ACS with Multivessel Disease. International Cardiovascular Forum Journal 2016. 6: p. 3-5.
2.  Ibrahim, H., et al., Multivessel Versus Culprit Vessel-Only Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction: Insights From the TRANSLATE-ACS Observational Study. J Am Heart Assoc, 2017. 6(10).
3.  Park, D.W., et al., Extent, location, and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction. Jama, 2014. 312(19): p. 2019-27.


About CSL Behring

CSL Behring is a global biotherapeutics leader driven by its promise to save lives. Focused on serving patients’ needs by using the latest technologies, we develop and deliver innovative therapies that are used to treat coagulation disorders, primary immune deficiencies, hereditary angioedema, inherited respiratory disease, and neurological disorders. The company’s products are also used in cardiac surgery, organ transplantation, burn treatment and to prevent hemolytic disease of the newborn.

CSL Behring operates one of the world’s largest plasma collection networks, CSL Plasma. The parent company, CSL Limited (ASX:CSL;USOTC:CSLLY), headquartered in Melbourne, Australia, employs more than 22,000 people, and delivers its life-saving therapies to people in more than 60 countries. For inspiring stories about the promise of biotechnology, visit Vita and follow us on

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