Antithrombotic Therapy and Direct Medical Costs in Patients with Acute Coronary Syndrome in Shanghai, China.

Abstract

Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality worldwide. This study aims to describe treatment patterns and disease burden for patients with ACS in Shanghai, China. A retrospective descriptive cohort study was conducted. Data were obtained from electronic medical records of seven major Shanghai medical centers. Patients who had at least one primary diagnosis of ACS between January 2006 and July 2012 were included in the study. Patient ACS-related antithrombotic medication use, laboratory tests, key comorbidities, health care utilization and direct medical costs were examined. Log-linear regression was conducted to explore the factors associated with total direct medical cost. A total of 6,601 patients were included with mean age of 69.7 (±SD12.5), 73% male and 10% mortality rate. 18.2% of studied patients had diabetes as a comorbidity, 21.2% had hypertension, and 8.6% had hyperlipidemia. 6,466 (98.0%) of patients had been hospitalized for ACS with mean 14.0 (±16.4) days per hospitalization. There were 1,022 patients (15.5%) presented to emergency department. Of those, 93.5% received any antithrombotic therapy, including 92.8% with antiplatelet agents and 20.8% with anticoagulants. The ACS-related direct medical costs were RMB19,421 (±24,741) per hospitalization with medication of RMB6,798 and lab tests of RMB1,355, and RMB2,894 (±7,060) per outpatient visit with medication of RMB624 and lab tests of RMB464. The higher direct medical cost was associated significantly (p<0.01) with aging, being male, antiplatelet and anticoagulant uses, diabetes, stroke, hyperlipidemia, hypertension, and chronic kidney diseases. Antithrombotic therapeutic treatments were commonly used among ACS patients in Shanghai, China. ACS poses significant disease burden to the health care system and patients. The higher treatment cost for patients with ACS involves antithrombotic use and key comorbidities.