Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both

Abstract

Background: The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS) alone and with common cardiovascular comorbidities.

Methods: A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF), ACS with heart failure (HF), and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables.

Results: Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191) followed by ACS with HF ($32,871±2,853), ACS with AF ($25,192±2,253), and ACS only ($17,954±563). Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719-9,427), $11,297 (95% CI 5,610-16,985), and $15,761 (95% CI 4,784-26,738) higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767), when compared with patients without these conditions.

Conclusion: ACS imposes a significant economic burden at both the individual and society level, particularly when with comorbid AF and HF.

Keywords: acute coronary syndromes; comorbid atrial fibrillation; costs; heart failure.

Figure 1

Estimated annual lost productivity for the US population because of epilepsy and other chronic conditions. Marginal effects from generalized linear model using log link and gamma distribution adjusted for sex, race, ethnicity, region, age, insurance status, epilepsy, diabetes, depression, anxiety, asthma, hypertension, number of other chronic conditions, and survey years; wage income expressed in 2011 US dollars. Note: Copyright © 2012. Wolters Kluwer Health. Reproduced with permission from Libby AM, Ghushchyan V, McQueen RB, Slejko JF, Bainbridge JL, Campbell JD. Economic differences in direct and indirect costs between people with epilepsy and without epilepsy. Med Care. 2012;50(11): 928–933. Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Lippincott Williams & Wilkins. Please contact journalpermissions@lww.com for further information.