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The High Cost of Death After Acute Myocardial Infarctions: Results from a National US Hospital Database
Peter J Mallow1, Frederick Browne1, Kamal Shemisa2
1Health Services Administration, Xavier University, Cincinnati, OH, USA.
Insights
Patients who died from acute myocardial infarction (AMI) had higher hospital costs and longer lengths of stay (LOS) compared to survivors. Economic models should account for the costs associated with mortality.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Healthcare Research
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality and morbidity worldwide.
- Understanding the economic impact of AMI, including differences between survivors and non-survivors, is crucial for resource allocation and healthcare policy.
- Previous studies have not comprehensively evaluated the cost and length of stay (LOS) differences in a nationally representative cohort, particularly considering mortality outcomes.
Purpose of the Study:
- To compare the hospital costs and length of stay (LOS) between patients who died and those who survived acute myocardial infarction (AMI).
- To identify factors contributing to cost and LOS variations in AMI patients.
- To inform economic evaluations of cardiovascular interventions by including the cost of mortality.
Main Methods:
- Utilized the 2019 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database.
- Analyzed data from patients with a principal diagnosis of AMI.
- Employed propensity-score matched analysis and multivariable regression to adjust for patient and hospital characteristics.
Main Results:
- A total of 9118 AMI patient visits were analyzed (4559 survivors, 4559 non-survivors).
- The adjusted mean hospital cost for patients who died was significantly higher ($23,173) compared to survivors ($18,970).
- Patients who died had a significantly longer adjusted length of stay (4.24 days) than survivors (3.95 days).
Conclusions:
- Patients who died from AMI incurred higher hospital costs and experienced longer lengths of stay than survivors.
- Increased LOS and higher-level care utilization contributed to the elevated costs in non-survivors.
- Economic evaluations of cardiovascular interventions may underestimate benefits if the costs associated with mortality are not considered.
Introduction:
This study described the differences in costs and length of stay (LOS) among patients with AMI who died versus survived using a large, nationally representative cohort of AMI patients.
Methods:
The 2019 HCUP NIS was used to analyze costs, and LOS among all patients with a principal diagnosis of AMI. A propensity-score matched analysis and multivariable regression were used to adjust for patient and hospital characteristics.
Results:
There were 4559 visits in each of the cohorts (total 9118). The adjusted mean hospital cost was $18,970 (95% CI $16,453 - $21,871) for those that survived and $23,173 (95% CI $20,167 - $26,626; p <0.001) for those that died. The LOS was 3.95 (95% CI 3.41-4.57) in survivors and 4.24 (95% CI 3.67-4.89; p <0.001) in those who died.
Conclusion:
Survivors of AMI incurred lower costs and length of stay than those who died. Higher costs were attributed to greater LOS and higher-level care. The results suggest that economic evaluations of cardiovascular interventions that do not include the cost of dying may underestimate the benefits of the intervention.
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