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Determining initial and follow-up costs of cardiovascular events in a US managed care population
Richard H Chapman1, Larry Z Liu, Prafulla G Girase
1US Health Economics & Outcomes Research, IMS Health, Falls Church, VA, USA. rchapman@us.imshealth.com
Insights
Cardiovascular events incur significant initial hospitalization costs and substantial follow-up healthcare expenses. These costs, particularly over 2-3 years, far exceed those of matched individuals without cardiovascular events.
Area of Science:
- Health Economics
- Cardiovascular Medicine
- Healthcare Management
Background:
- Cardiovascular (CV) events represent a significant global health burden with substantial direct medical and follow-up costs.
- Understanding these costs is crucial for healthcare resource allocation and patient management.
Purpose of the Study:
- To determine the initial and follow-up healthcare costs associated with cardiovascular events in US managed care enrollees.
- To compare these costs against a matched cohort of patients without cardiovascular events.
Main Methods:
- A 5.5-year retrospective matched cohort analysis using claims data from approximately 90 US health plans.
- Identification of patients hospitalized for their first CV event and matching them with controls lacking CV-related claims.
- Endpoint analysis included total direct medical costs for inpatient, outpatient, and pharmacy services.
Main Results:
- Mean initial inpatient costs for CV events were $16,981, varying by event type (e.g., $6,699 for transient ischemic attack to $56,024 for CABG).
- Mean 1-year follow-up costs were $16,582, representing an excess of $13,792 compared to controls.
- This cost difference widened significantly at 2 and 3 years post-event ($20,862 and $26,014, respectively).
Conclusions:
- Healthcare costs following cardiovascular events vary widely depending on the specific event type.
- Follow-up costs within the first year approximate initial hospitalization costs, with costs escalating significantly in subsequent years.
- Cardiovascular events are associated with substantially higher long-term healthcare expenditures compared to non-affected individuals.
Background:
Cardiovascular (CV) events are prevalent and expensive worldwide both in terms of direct medical costs at the time of the event and follow-up healthcare after the event. This study aims to determine initial and follow-up costs for cardiovascular (CV) events in US managed care enrollees and to compare to healthcare costs for matched patients without CV events.
Methods:
A 5.5-year retrospective matched cohort analysis of claims records for adult enrollees in ~90 US health plans. Patients hospitalized for first CV event were identified from a database containing a representative sample of the commercially-insured US population. The CV-event group (n = 29,688) was matched to a control group with similar demographics but no claims for CV-related events. Endpoints were total direct medical costs for inpatient and outpatient services and pharmacy (paid insurance amount).
Results:
Overall, mean initial inpatient costs were US dollars ($) 16,981 per case (standard deviation [SD] = $20,474), ranging from $6,699 for a transient ischemic attack (mean length of stay [LOS] = 3.7 days) to $56,024 for a coronary artery bypass graft (CABG) (mean LOS = 9.2 days). Overall mean health-care cost during 1-year follow-up was $16,582 (SD = $34,425), an excess of $13,792 over the mean cost of matched controls. This difference in average costs between CV-event and matched-control subjects was $20,862 and $26,014 after two and three years of follow-up. Mean overall inpatient costs for second events were similar to those for first events ($17,705/case; SD = $22,703). The multivariable regression model adjusting for demographic and clinical characteristics indicated that the presence of a CV event was positively associated with total follow-up costs (P < 0.0001).
Conclusions:
Initial hospitalization and follow-up costs vary widely by type of CV event. The 1-year follow-up costs for CV events were almost as high as the initial hospitalization costs, but much higher for 2- and 3-year follow-up.
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