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Comparative Study
. 2011 Mar 16:11:11.
doi: 10.1186/1471-2261-11-11.

Determining initial and follow-up costs of cardiovascular events in a US managed care population

Richard H Chapman  1 , Larry Z Liu, Prafulla G Girase, Robert J Straka
Affiliations
Comparative Study

Determining initial and follow-up costs of cardiovascular events in a US managed care population

Richard H Chapman et al. BMC Cardiovasc Disord. .

Abstract

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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Figures

Figure 1
Figure 1
Diagram of study cohort identification procedure.
Figure 2
Figure 2
Unadjusted cost of total medical care in the follow-up period, among (matched) CV-event (CVE) and control - (CTRL) subjects.
See this image and copyright information in PMC

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