PCV21 Cost Consequences of Acute Myocardial Infarction in Diabetic Patients-The First Year

Abstract

In developing an economic model of type 2 diabetes mellitus, the costs associated with its complications were examined. This presentation focuses on the first year costs associated with acute myocardial infarction (MI). OBJECTIVE: To estimate the first year costs of initial acute care (accommodation, procedure and ancillary hospital charges and MD fees) and subsequent care (rehabilitation, nursing, home health care, physician visits, lab, medications, surgical and invasive cardiovascular procedures occurring post-discharge) accrued in the management of MI in diabetic patients. METHODS: Estimates for these costs were developed based on data from five all payer, acute care, state discharge databases (CA, FL, MA, MD, NC) and MA long term care data, using ICD9 codes to identify disease and procedure level data. These sources were supplemented by fee schedules, other agency and survey data and the literature. The proportions of patients consuming each type of subsequent resource use were estimated from discharge data for each population and published literature. All costs are reported in 1996 US$, adjusted appropriately for medical inflation and cost-to-charge ratios. RESULTS: Approximately 31,000 discharges of diabetic patients with a principal diagnosis of AMI were identified. The initial hospitalization was 7 days, on average, with a mean cost of $16,520. The case fatality rate in hospital was 11%, and 38% received some type of subsequent care post-discharge. Thus, hospitalization accounted for 60% of the total average first year costs ($27,630) accrued. CONCLUSION: Increased medical management resulting from an MI, which continues beyond the first year, adds a substantial cost burden. Avoidance of macrovascular complications should be a key goal of diabetes management.