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Canadian Journal of Cardiology

Resource Use and Burden of Hospitalization, Outpatient, Physician, and Drug Costs in Short- and Long-term Care After Acute Myocardial Infarction

  • Dat T. Tran
    Correspondence
    Corresponding author: Dr Dat T. Tran, Canadian VIGOUR Centre, University of Alberta, 2-132 Li Ka Shing Centre, 8602 112 St, Edmonton, Alberta T6G 2E1, Canada. Tel.: +1-780-492-8383; fax: +1-780-492-0613.
    Affiliations
    School of Public Health, University of Alberta, Edmonton, Alberta, Canada

    Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
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  • Robert C. Welsh
    Affiliations
    Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada

    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Canada
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  • Arto Ohinmaa
    Affiliations
    School of Public Health, University of Alberta, Edmonton, Alberta, Canada

    Institute of Health Economics, Edmonton, Alberta, Canada
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  • Nguyen X. Thanh
    Affiliations
    School of Public Health, University of Alberta, Edmonton, Alberta, Canada

    Institute of Health Economics, Edmonton, Alberta, Canada
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  • Padma Kaul
    Affiliations
    Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada

    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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      Abstract

      Background

      Little is known about the resource use and cost burden of acute myocardial infarction (AMI) beyond the index event. We examined resource use and care costs during the first and each subsequent year, among patients with incident AMI.

      Methods

      Patients aged ≥18 years who were admitted with incident AMI at emergency departments or hospitals in Alberta, Canada, between April 2004 and March 2014 were included. Incident cases were defined as those without an AMI hospitalization in the previous 10 years. Inpatient, outpatient, practitioner claims, drug claims, and vital statistics were linked and follow-up data were available until March 2016. Resource use and care costs per patient for each year after the AMI were calculated.

      Results

      The analysis included 41,210 patients with incident AMI (non–ST-segment elevation myocardial infarction [NSTEMI] = 50.8%, ST-segment elevation myocardial infarction = 36.8%, and undefined myocardial infarction [MI] = 12.5%). Resource use and care costs were highest during the first year. Compared with other MI groups, patients with ST-segment elevation myocardial infarction had more frequent outpatient visits (mean 1.64 vs 0.99 [NSTEMI] and 0.87 [undefined MI] visits) but spent fewer days in hospital (mean 7.72 vs 9.23 [NSTEMI] and 8.5 [undefined MI] days) during the first year. AMI costs were $19,842 during the first year and $845 per year for the next 5 years. Hospitalization costs accounted for the majority of costs during the first year (81.1%), whereas drug costs did for the next 5 years (62.1%).

      Conclusions

      The long-term annual cost burden of AMI is modest compared with care costs during the first year. Although hospitalization dominates first year costs, pharmaceuticals do so in the long term.

      Résumé

      Introduction

      On en connaît peu sur l’utilisation des ressources et le fardeau des coûts de l’infarctus du myocarde aigu (IMA) après le premier événement. Nous avons examiné l’utilisation des ressources et le coût des soins au cours de la première année et de chacune des années subséquentes chez les patients ayant subi un premier IMA.

      Méthodes

      Nous avons choisi les patients de ≥ 18 ans qui avaient été admis en raison d’un premier IMA aux services des urgences ou dans des hôpitaux de l’Alberta, au Canada, entre avril 2004 et mars 2014. Les nouveaux cas ont été définis comme suit : les patients qui n’ont pas été hospitalisés en raison d’un IMA au cours des 10 dernières années. Les données sur les patients hospitalisés, les patients en consultation externe, les demandes de remboursement des praticiens, les demandes de remboursement de médicaments et les statistiques de l’état civil ont été liées et les données sur le suivi sont demeurées accessibles jusqu’en mars 2016. Nous avons évalué l’utilisation des ressources et calculé le coût des soins par patient pour chacune des années après l’IMA.

      Résultats

      L’analyse regroupait 41 210 patients ayant subi un premier IMA (infarctus du myocarde [IM] sans élévation du segment ST = 50,8 %, IM avec élévation du segment = 36,8 % et IM non défini = 12,5 %). L’utilisation des ressources et le coût des soins étaient plus élevés au cours de la première année. Comparativement aux autres groupes d’IM, les patients ayant subi un IM avec élévation du segment ST avaient de plus nombreuses visites en consultation externe (moyenne, 1,64 vs 0,99 [IM sans élévation du segment ST] et 0,87 [IM non défini] visite), mais passaient moins de jours à l’hôpital (moyenne, 7,72 vs 9,23 [IM sans élévation du segment ST] et 8,5 [IM non défini] jours) au cours de la première année. Les coûts associés à l’IMA s’élevaient à 19 842 $ au cours de la première année et à 845 $ par année durant les 5 années suivantes. Les coûts d’hospitalisation représentaient la majorité des coûts au cours de la première année (81,1 %), alors que les coûts de médicaments représentaient la majorité des coûts des 5 années suivantes (62,1 %).

      Conclusions

      Le fardeau à long terme des coûts annuels de l’IMA est modeste par rapport aux coûts des soins au cours de la première année. Bien que les coûts d’hospitalisation dominent au cours de la première année, les coûts de médicaments dominent à long terme.
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      References

        • Turpie A.G.
        Burden of disease: medical and economic impact of acute coronary syndromes.
        Am J Manag Care. 2006; 12: S430-S434
        • Mendis S.
        • Puska P.
        • Norrving B.
        • World Health Organization, World Heart Federation, World Stroke Organization
        Global Atlas on Cardiovascular Disease Prevention and Control.
        World Health Organization in Collaboration With the World Heart Federation and the World Stroke Organization, Geneva2011
        • OECD
        Health at a Glance 2015.
        OECD Publishing, Paris2015
        • Curtis J.P.
        • Schreiner G.
        • Wang Y.
        • et al.
        All-cause readmission and repeat revascularization after percutaneous coronary intervention in a cohort of Medicare patients.
        J Am Coll Cardiol. 2009; 54: 903-907
        • O'Gara P.T.
        • Kushner F.G.
        • Ascheim D.D.
        • et al.
        2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions.
        Catheter Cardiovasc Interv. 2013; 82: E1-E27
        • Steg P.G.
        • James S.K.
        • Atar D.
        • et al.
        ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
        Eur Heart J. 2012; 33: 2569-2619
        • Roffi M.
        • Patrono C.
        • Collet J.-P.
        • et al.
        2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2016; 37: 267-315
        • Drummond M.
        Methods for the Economic Evaluation of Health Care Programmes.
        3rd ed. Oxford University Press, New York2005
        • Heidenreich P.A.
        • Trogdon J.G.
        • Khavjou O.A.
        • et al.
        Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.
        Circulation. 2011; 123: 933-944
        • Leal J.
        • Luengo-Fernández R.
        • Gray A.
        • Petersen S.
        • Rayner M.
        Economic burden of cardiovascular diseases in the enlarged European Union.
        Eur Heart J. 2006; 27: 1610-1619
        • Seo H.
        • Yoon S.J.
        • Yoon J.
        • et al.
        Recent trends in economic burden of acute myocardial infarction in South Korea.
        PLoS One. 2015; 10e0117446
        • Soekhlal R.R.
        • Burgers L.T.
        • Redekop W.K.
        • Tan S.S.
        Treatment costs of acute myocardial infarction in the Netherlands.
        Neth Heart J. 2013; 21: 230-235
        • Mantovani L.G.
        • Fornari C.
        • Madotto F.
        • et al.
        Burden of acute myocardial infarction.
        Int J Cardiol. 2011; 150: 111-112
        • Tiemann O.
        Variations in hospitalisation costs for acute myocardial infarction—a comparison across Europe.
        Health Econ. 2008; 17: S33-S45
      1. Alberta Health. Overview of Administrative Health Datasets.
        (Available at:) (Accessed December 1, 2017)
      2. Tran DT, Ohinmaa A, Thanh NX, Welsh RC, Kaul P. The healthcare cost burden of acute myocardial infarction in Alberta, Canada [Epub ahead of print]. Phar-macoecon Open https://doi.org/10.1007/s41669-017-0061-0, accessed July 15, 2018.

      3. Canadian Institute for Health Information. Canadian Classification of Health Interventions.
        (Available at:) (Accessed February 26, 2015)
      4. Alberta Interactive Health Data Application. Interactive Health Data Application.
        (Available at:) (Accessed July 16, 2016)
      5. Alberta Health—Health Analytics Branch. Indicator: Hospital Inpatient Case Costing, 2014.

      6. Alberta Health—Health Analytics Branch. Indicator: Hospital Ambulatory Care Case Costing, 2014.

        • Manning W.G.
        • Mullahy J.
        Estimating log models: to transform or not to transform?.
        J Health Econ. 2001; 20: 461-494
        • Jneid H.
        • Anderson J.L.
        • Wright R.S.
        • et al.
        2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2012; 60: 645-681
      7. Alberta Health. Interactive Drug Benefit List.
        (Available at:) (Accessed September 10, 2017)
      8. Canada Drugs. Drug Price.
        (Available at:) (Accessed September 10, 2016)
        • Quan H.
        • Sundararajan V.
        • Halfon P.
        • et al.
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Med Care. 2005; 43: 1130-1139
      9. Bank of Canada. Inflation Calculator.
        (Available at:) (Accessed August 25, 2016)
      10. Statistics Canada. Consumer Price Index.
        (Available at:) (Accessed April 30, 2016)
        • Jhund P.S.
        • McMurray J.J.V.
        Heart failure after acute myocardial infarction. A lost battle in the war on heart failure?.
        Circulation. 2008; 118: 2019-2021
        • Tran D.T.
        • Ohinmaa A.
        • Thanh N.X.
        • et al.
        The current and future financial burden of hospital admissions for heart failure in Canada: a cost analysis.
        CMAJ Open. 2016; 4: E365-E370
      11. Canadian Forex. Canadian Foreign Exchange Services—Historical Rates.
        (Available at:) (Accessed July 4, 2017)
        • Mehta R.H.
        • Kaul P.
        • Lopes R.D.
        • et al.
        Variations in practice and outcomes in patients undergoing primary percutaneous coronary intervention in the United States and Canada: insights from the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI) trial.
        Am Heart J. 2012; 163: 797-803
        • Kauf T.L.
        • Velazquez E.J.
        • Crosslin D.R.
        • et al.
        The cost of acute myocardial infarction in the new millennium: evidence from a multinational registry.
        Am Heart J. 2006; 151: 206-212
      12. Patented Medicine Prices Review Board Annual Report, 2015. Ottawa, 2016.

        • Pasterkamp G.
        • den Ruijter H.M.
        • Libby P.
        Temporal shifts in clinical presentation and underlying mechanisms of atherosclerotic disease.
        Nat Rev Cardiol. 2017; 14: 21-29
      13. Statistics Canada. Table 052-0005—Estimates of population, by age group and sex for July 1, Canada, provinces and territories.
        (Available at:) (Accessed July 6, 2017)
        • Fokkema M.L.
        • James S.K.
        • Albertsson P.
        • et al.
        Population trends in percutaneous coronary intervention: 20-year results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry).
        J Am Coll Cardiol. 2013; 61: 1222-1230
        • Venkitachalam L.
        • Kip K.E.
        • Selzer F.
        • et al.
        Twenty-year evolution of percutaneous coronary intervention and its impact on clinical outcomes: a report from the National Heart, Lung, and Blood Institute-sponsored, multicenter 1985-1986 PTCA and 1997-2006 Dynamic Registries.
        Circ Cardiovasc Interv. 2009; 2: 6-13
        • Afana M.
        • Brinjikji W.
        • Cloft H.
        • Salka S.
        Hospitalization costs for acute myocardial infarction patients treated with percutaneous coronary intervention in the United States are substantially higher than Medicare payments.
        Clin Cardiol. 2015; 38: 13-19
        • Tran D.T.
        • Welsh R.C.
        • Ohinmaa A.
        • Thanh N.X.
        • Kaul P.
        Temporal trends of reperfusion strategies and hospital mortality for patients with STEMI in percutaneous coronary intervention-capable hospitals.
        Can J Cardiol. 2017; 33: 485-492
        • Tran D.T.
        • Welsh R.C.
        • Ohinmaa A.
        • et al.
        Quality of acute myocardial infarction care in Canada: a 10-year review of 30-day in-hospital mortality and 30-day hospital readmission.
        Can J Cardiol. 2017; 33: 1319-1326
        • Canadian Institute for Health Information
        National Health Expenditure Trends, 1975 to 2016.
        CIHI, Ottawa, ON2016
        • Schull M.J.
        • Vaillancourt S.
        • Donovan L.
        • et al.
        Underuse of prehospital strategies to reduce time to reperfusion for ST-elevation myocardial infarction patients in 5 Canadian provinces.
        CJEM. 2009; 11: 473-480