Direct healthcare costs and resource consumption after acute coronary syndrome: a real-life analysis of an Italian subpopulation

Abstract

Background

Acute coronary syndrome (ACS) is the most common cause of morbidity and mortality in Italy and worldwide. Aim of this study was to evaluate the average annual direct healthcare costs for the treatment of patients with a recent hospitalization for ACS.

Design and methods

The direct medical costs of patients with a first ACS hospitalization (index event) in the period from 1 January 2008 to 31 December 2008 were estimated for a 1-year follow-up period. The resource consumption was measured in terms of: reimbursed drugs, diagnostic procedures, outpatient visits, and hospitalizations. The analysis was performed from the Italian National Health Service perspective.

Results

A total of 2,758,872 subjects were observed, 7082 (35.8% women) of whom being hospitalized for ACS during the accrual period (2.6‰). Among patients with ACS, 60% were medically treated, 33.1% were treated with percutaneous coronary intervention (PCI), and 6.9% died during the index hospitalization. Dual antiplatelet treatment (ASA plus clopidogrel) was prescribed in 25.9% of the medically treated ACS patients and in 70.1% of the ACS patients treated with PCI. The average yearly cost per patient for the total ACS population was 11,464€/year (drugs 1304€; hospitalizations 9655€; diagnostic and outpatient visits 505€). The average annual cost was 10,862€ for medically treated patients and 14,111€ for patients treated with PCI. Patients who died of cardiovascular events during follow up had an average cost of 16,231€/patient.

Conclusions

Patients with ACS had higher direct healthcare costs, their management and rehospitalizations being the main cost drivers.

Keywords

Acute coronary syndrome cost of illness direct healthcare costs healthcare resource use

Get full access to this article

View all access options for this article.

References

Roger

Lloyd-Jones

. Heart disease and stroke statistics – 2011 update: a report from the American Heart Association. Circulation 2013; 123: e18–e209.

Federazione Italiana di Cardiologia. Documento di Consenso: Sindromi coronariche acute senza sopralivellamento del tratto ST. G Ital Cardiol 2009; 10(Suppl 1–6): 5S–24S.

Wieser

Rüthemann

De Boni

. Cost of acute coronary syndrome in Switzerland in 2008. Swiss Med Wkly 2012; 142: w13655–w13655.

Gruppo di lavoro OsMed. L’uso dei farmaci in Italia. Rapporto nazionale anno 2010. Roma: Il Pensiero Scientifico Editore. Available at: http://www.agenziafarmaco.gov.it/it/content/luso-dei-farmaci-italia-rapporto-osmed-2010 (2011, consulted June 2012).

Rapporto annuale sull’attività di ricovero ospedaliero. Dati SDO 2010. Roma: Ministero della salute. Available at: http://www.salute.gov.it/ricoveriOspedalieri/ricoveriOspedalieri.jsp (2012, consulted June 2012).

Mahoney

Wang

Arnold

. Cost-effectiveness of prasugrel versus clopidogrel in patients with acute coronary syndromes and planned percutaneous coronary intervention: results from the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with Prasugrel-Thrombolysis in Myocardial Infarction TRITONTIMI 38. Circulation 2010; 121: 71–79.

Schwartz

Olsson

Ezekowitz

. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 2001; 285: 1711–1718.

Mahoney

Mehta

Yuan

. Longterm cost-effectiveness of early and sustained clopidogrel therapy for up to 1 year in patients undergoing percutaneous coronary intervention after presenting with acute coronary syndromes without ST-segment elevation. Am Heart J 2006; 151: 219–227.

Sicras-Mainar

Fernández de Bobadilla

Navarro-Artieda

. Morbi-mortality and use of resources after acute coronary syndrome in a Spanish population. Rev Clin Esp 2013; 211: 560–571.

10.

Wijns

Kolh

Danchin

. Guidelines on myocardial revascularization: the Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010; 31: 2501–2555.

11.

Bauer

Gitt

Jünger

. Guideline-recommended secondary prevention drug therapy after acute myocardial infarction: predictors and outcomes of nonadherence. Eur J Cardiovasc Prev Rehabil 2010; 17: 576–581.

12.

European Guidelines on cardiovascular disease prevention in clinical practice. (version 2012) the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2012; 19: 585–667.

13.

Italian national tariffs for the supply of hospital care for the year 2008. Conference of the Regions and Autonomous Provinces. Available at: http://www.regione.emilia-romagna.it/sas/nosologiche/delibere_circ/del1863_2008/calcolo_tuc_2008.pdf (2009, consulted March 2012).

14.

Casella

Cassin

Chiarella

. Epidemiology and patterns of care of patients admitted to Italian intensive cardiac care units: the BLITZ-3 registry. J Cardiovasc Med 2010; 11: 450–461.

15.

Rizzello

Lucci

Maggioni

. Clinical epidemiology, management and outcome of acute coronary syndromes in the Italian network on acute coronary syndromes (IN-ACS Outcome study). Acute Card Care 2012; 14: 71–80.

16.

Casella

Di Pasquale

Oltrona Visconti

. Management of patients with acute coronary syndromes in real-world practice in Italy: an outcome research study focused on the use of ANTithRombotic Agents: the MANTRA registry. European Heart Journal: Acute Cardiovascular Care 2013. Epub ahead of print 9 January 2013. DOI: 10.1177/2048872612471213.

17.

Mandelzweig

Battler

Boyko

. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J 2006; 27: 2285–2293.

18.

Alexander

Roe

Chen

. for the CRUSADE Investigators. Evolution in cardiovascular care for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. J Am Coll Cardiol 2005; 46: 1479–1487.

19.

Anand

Xie

Mehta

. for the CURE Investigators. Differences in the management and prognosis of women and men who suffer from acute coronary syndromes. J Am Coll Cardiol 2005; 46: 1845–1851.

20.

Redberg

. Gender, race, and cardiac care: why the differences? J Am Coll Cardiol 2005; 46: 1852–1854.

21.

Lansky

Hochman

Ward

. Percutaneous coronary intervention and adjunctive pharmacotherapy in women: a statement for healthcare professionals from the American Heart Association. Circulation 2005; 111: 940–953.

22.

American Heart Association. Heart disease and stroke statistics − 2005 update, Dallas, TX: American Heart Association, 2004.

23.

Mueller

Neumann

Roskamm

. Women do have an improved long-term outcome after non-ST-elevation acute coronary syndromes treated very early and predominantly with percutaneous coronary intervention: a prospective study in 1,450 consecutive patients. J Am Coll Cardiol 2002; 40: 245–250.

24.

Stone

Grines

Browne

. Comparison of in-hospital outcome in men versus women treated by either thrombolytic therapy or primary coronary angioplasty for acute myocardial infarction. Am J Cardiol 1995; 75: 987–992.

25.

Glaser

Herrmann

Murphy

. Benefit of an early invasive management strategy in women with acute coronary syndromes. JAMA 2002; 288: 3124–3129.

26.

Savonitto

Colombo

Bossi

. Il paziente anziano con sindrome coronarica acuta: maggiore il rischio, minore la cura. G Ital Cardiol 2006; 7(Suppl 1–4): 21S–29S.

27.

Di Chiara

Fresco

Savonitto

. for the BLITZ-2 Investigators. Epidemiology of non-ST elevation acute coronary syndromes in the Italian cardiology network: the BLITZ-2 study. Eur Heart J 2006; 27: 393–405.

28.

Zhao

Winget

. Economic burden of illness of acute coronary syndromes: medical and productivity costs. Health Services Research 2013; 11: 35–35.

29.

Johnston

Curkendall

Makenbaeva

. The direct and indirect cost burden of acute coronary syndrome. J Occup Environ Med 2013; 53: 2–7.

30.

Etemad

McCollam

. Total first-year costs of acute coronary syndrome in a managed care setting. J Manag Care Pharm 2005; 11: 300–306.