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Costs and benefits associated with treatment for coronary artery disease
Insights
Comparing treatment costs for coronary artery disease, surgical interventions were more expensive than medical therapy. Myocardial infarctions significantly predicted higher costs, impacting patient return to work and perceived health status.
Area of Science:
- Cardiovascular Medicine
- Health Economics
Background:
- Coronary Artery Surgery Study (CASS) and Cooperative Unstable Angina Study (UAS) provide data on medical and surgical treatments for coronary artery disease.
- Understanding treatment costs is crucial for healthcare decision-making.
Purpose of the Study:
- To present direct and indirect costs of medical versus surgical treatments for patients in the CASS and UAS.
- To identify predictors of cost and analyze patient outcomes like return to work and perceived health.
Main Methods:
- Cost analysis of inpatient treatments for stable and unstable angina.
- Stepwise multiple regression and discriminant-function analysis to identify cost predictors and patient subgroups.
Main Results:
- In UAS, 1-year costs were $6867 (medical), $10,574 (surgical), and $23,045 (late surgery).
- Number of myocardial infarctions was the strongest cost predictor. Discriminant analysis identified 85% of medical patients needing late surgery.
- Surgical patients had lower return-to-work rates than medical patients in UAS. CASS patients had 1-year costs of $3432 (medical), $11,100 (surgical), and $13,554 (late surgery).
Conclusions:
- Surgical treatment for coronary artery disease generally incurs higher costs than medical therapy.
- Patient outcomes, including return to work and perceived health, vary between treatment groups, with surgical patients reporting better health perception.
- Myocardial infarction history is a key factor influencing treatment costs.
Abstract:
Direct and indirect costs of medical and of surgical treatment are presented for patients entered into the Birmingham portion of the Coronary Artery Surgery Study. For comparison, similar results are shown for the Birmingham portion of the national Cooperative Unstable Angina Study. In the Unstable Angina Study, mean inpatient costs at the end of 1 year in the study were $6867 for medical therapy, $10,574 for surgical therapy and $23,045 for those who failed medical therapy and required late surgery. A stepwise multiple regression analysis shows that the single best predictor of cost was the number of myocardial infarctions that the patient had while in the study. A discriminant-function analysis identified 85% of the medical patients who required late surgery. A significantly lower proportion of surgical than medical patients returned to work. Total inpatient costs for patients in the Coronary Artery Surgery Study (i.e, patients with stable angina) were $3432, $11,100 and $13,554 for medical, surgical and late surgical patients, respectively, for the first year in the study. There was no significant difference in the percentage of medical and surgical patients who were working at the end of 1 year. According to their own perceptions, the surgical group was in the best and the late surgical group in the worst health.