Abstract
BackgroundThe significant economic burden associated with acute coronary syndromes (ACS) provides a need to evaluate both medical costs and productivity costs, according to evolving guideline-driven ACS treatment strategies, medical management (MM), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG).MethodsCommercially insured individuals, aged 18-64, with an emergency room (ER) visit or hospitalization accompanied by an ACS diagnosis (index event) were identified from a large claims database between 01/2004 and 12/2005 with a 1-year follow-up period. Patients who had an ACS diagnosis in the 12 months prior to their index event were excluded. Patients were divided into 3 groups according to treatment strategies during the index event: MM, PCI, or CABG. A subset of patients was identified for the productivity cost analysis exploring short-term disability and absenteeism costs. Multivariate generalized linear models were performed to examine the ACS costs by 3 different treatment strategies.ResultsA total of 10,487 patients were identified for the medical cost analysis. The total 1-year medical costs (index event costs plus the 1-year follow-up costs) were lowest for MM patients ($34,087), followed by PCI patients ($52,673) and CABG patients ($86,914). Of the 3,080 patients in the productivity costs analysis, 2,454 patients were identified in the short-term disability cohort and 626 patients were identified in the absenteeism cohort. Both the estimated mean total 1-year short-term disability and absenteeism costs were highest for CABG patients ($17,335, $14,960, respectively) compared to MM patients ($6,048, $9,826, respectively) and PCI patients ($9,221, $9,460, respectively).ConclusionsBoth total 1-year medical costs and 1-year productivity costs are substantial for working-aged individuals with ACS. These costs differ according to the type of treatment strategy, with CABG having higher costs compared to either PCI or MM.
Highlights
The significant economic burden associated with acute coronary syndromes (ACS) provides a need to evaluate both medical costs and productivity costs, according to evolving guideline-driven ACS treatment strategies, medical management (MM), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG)
Patient Characteristics A total of 10,487 ACS patients was identified and divided into three mutually exclusive groups according to treatment strategy during their index event: MM (n = 4,894), PCI (n = 4,729), and CABG (n = 864)
Patients in the PCI and CABG groups had significantly (p < 0.05) longer mean lengths of stay compared to MM patients during the index event: 3.14 days, 8.65 days, and 1.63 days, respectively
Summary
The significant economic burden associated with acute coronary syndromes (ACS) provides a need to evaluate both medical costs and productivity costs, according to evolving guideline-driven ACS treatment strategies, medical management (MM), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). The substantial costs associated with ACS include treatment related medical costs, as well as costs due to loss of productivity [3]. Previous studies evaluating medical costs have shown total first-year treatment cost estimates to be $22,528 to $32,345, with the majority of these costs due to hospitalizations [4,5,6]. The American Heart Association estimates that loss of productivity for coronary heart disease will account for nearly $81.1 billion in 2009, and there are limited data available on the productivity costs of ACS [1]. With prior studies concentrating on the medical costs associated with ACS, there is an unmet need for research exploring the impact of productivity costs
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