The Direct and Indirect Cost Burden of AcuteCoronary Syndrome

Thomson Reuters, Washington, DC, USA.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine (Impact Factor: 1.63). 01/2011; 53(1):2-7. DOI: 10.1097/JOM.0b013e31820290f4
Source: PubMed

ABSTRACT Quantify the incremental health care costs and workplace absence and short-term disability costs, to payers and employers, of patients hospitalized for acute coronary syndrome (ACS).
Retrospective study using medical insurance claims for the years 2002 to 2007. Patients were aged 18 to 64 years and hospitalized for ACS between January 1, 2003, and December 31, 2006; comparison patients without evidence of coronary artery disease were also selected. The incremental impact of ACS was estimated using weighted regression.
30,200 ACS patients were selected. Incremental annual direct costs of ACS were $40,671 (P < 0.001). For the indirect cost sub-analyses, incremental short-term disability costs of ACS were $999 (P < 0.001) and incremental absence costs were insignificant (P = 0.314) but from a small sample (N = 416).
Patients with ACS impose a substantial direct cost burden on employers and payers and a substantial indirect cost burden on employers. Acute coronary syndrome is more costly to employers and payers than other health conditions that are common among employed persons. Rehospitalizations after the initial hospitalization are common and represent a large portion of the cost.

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    • "Recent research has identified the heavy burden of hospital readmission for patients diagnosed with acute coronary syndrome, including those with unstable angina and NSTEMI.12 Therefore, the primary endpoint comprised a composite of cardiac-related events within 30 days and one year of discharge from the emergency department, including return to the emergency department with cardiac symptoms and subsequent cardiac diagnosis, cardiac rehospitalization, and/or cardiac death. "
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    ABSTRACT: We sought to examine the prognostic value of heart rate turbulence derived from electrocardiographic recordings initiated in the emergency department for patients with non-ST elevation myocardial infarction (NSTEMI) or unstable angina. Twenty-four-hour Holter recordings were started in patients with cardiac symptoms approximately 45 minutes after arrival in the emergency department. Patients subsequently diagnosed with NSTEMI or unstable angina who had recordings with ≥18 hours of sinus rhythm and sufficient data to compute Thrombolysis In Myocardial Infarction (TIMI) risk scores were chosen for analysis (n = 166). Endpoints were emergent re-entry to the cardiac emergency department and/or death at 30 days and one year. In Cox regression models, heart rate turbulence and TIMI risk scores together were significant predictors of 30-day (model chi square 13.200, P = 0.001, C-statistic 0.725) and one-year (model chi square 31.160, P < 0.001, C-statistic 0.695) endpoints, outperforming either measure alone. Measurement of heart rate turbulence, initiated upon arrival at the emergency department, may provide additional incremental value in the risk assessment for patients with NSTEMI or unstable angina.
    Vascular Health and Risk Management 08/2013; 9(1):465-73. DOI:10.2147/VHRM.S43654
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    • "This result is attributed to the age distribution of the study population with the results showing high morbidity and mortality in those aged below 70 years, which is consistent with the results of other studies [4,23]. However, the high percentage of indirect costs in our study contrasts with the results of Johnston et al. [24]. The low proportion of indirect costs in the study by Johnston et al. may be due to differences in the measurement methods in the two studies; thus, it is difficult to compare the two results. "
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    ABSTRACT: Acute coronary syndrome (ACS) is highly prevalent in Korea and is the third-leading cause of death in Korea; however, the economic cost of ACS on Korean society has not been investigated. This study examined the economic effect of ACS on the Korean population during the period 2004 to 2009. The analysis used the cost of illness (COI) framework. Data on direct medical costs, direct non-medical costs, and productivity loss related to ACS morbidity and mortality were included. The Korean National Health Insurance Corporation's claim database was used to obtain data on annual healthcare utilization and expenditures for the entire South Korean population. By using a data mining technique, we identified healthcare claims with ACS-related disease codes. Costs were estimated by using a macro-costing method. In 2009, the prevalence of ACS in Korea was 6.4 persons per 1,000 population members and the associated mortality rate was 20.2 persons per 100,000 population members. The total cost of ACS in 2009 was USD 918.2 million. Of the total, direct medical cost was USD 425.3 million, direct non-medical cost was USD 11.4 million, and cost associated with morbidity and mortality was USD 481.5 million. The results show that the total cost of ACS to the Korean society is high. Early and effective management of ACS is required to reduce ACS-associated mortality and morbidity. We suggest that further research be undertaken to determine ways to reduce the economic effects of ACS and its treatment.
    BMC Cardiovascular Disorders 08/2013; 13(1):55. DOI:10.1186/1471-2261-13-55 · 1.88 Impact Factor
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    ABSTRACT: Background: Cardiovascular disease (CVD) continues to be a leading cost driver for payers in the United States.1 The American Heart Association estimates that more than 75 million individuals nationwide have some form of CVD. Individuals aged 20 to 45 years are developing CVD at higher rates than ever before. Objectives: To discuss the alarming increase in the rate of CVD in young adults (aged 18-45 years) previously only seen in older adults (aged ≥65 years) and describe the 5 primary risk factors (smoking, obesity, hypertension, diabetes, and dyslipidemia) that contribute to this new trend in the working-age population. Discussion: Using Medical Expenditure Panel Survey data, this article outlines the increased prevalence of the 3 primary components of CVD-stroke, heart failure, and myocardial infarction-in younger adults and the cost impact on payers and on US society. The examples provided in this article highlight the need for increased efforts by all healthcare stakeholders, and by payers in particular, to develop prevention strategies for CVD risk factors targeted at young adults to curb the alarming rise in CVD among this age-group. Conclusion: This article provides compelling evidence for the need to institute prevention measures to curb the growing prevalence of CVD risk factors among younger adults in the United States.
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