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. 2016 Jan 20;2(2):125-140.
doi: 10.1093/ehjqcco/qcw003.

Long-term healthcare use and costs in patients with stable coronary artery disease: a population-based cohort using linked health records (CALIBER)

Simon Walker  1 , Miqdad Asaria  1 , Andrea Manca  1 , Stephen Palmer  1 , Chris P Gale  2 , Anoop Dinesh Shah  3 , Keith R Abrams  4 , Michael Crowther  5 , Adam Timmis  6 , Harry Hemingway  3 , Mark Sculpher  1
Affiliations

Long-term healthcare use and costs in patients with stable coronary artery disease: a population-based cohort using linked health records (CALIBER)

Simon Walker et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Aims: To examine long-term healthcare utilization and costs of patients with stable coronary artery disease (SCAD).

Methods and results: Linked cohort study of 94 966 patients with SCAD in England, 1 January 2001 to 31 March 2010, identified from primary care, secondary care, disease, and death registries. Resource use and costs, and cost predictors by time and 5-year cardiovascular disease (CVD) risk profile were estimated using generalized linear models. Coronary heart disease hospitalizations were 20.5% in the first year and 66% in the year following a non-fatal (myocardial infarction, ischaemic or haemorrhagic stroke) event. Mean healthcare costs were £3133 per patient in the first year and £10 377 in the year following a non-fatal event. First-year predictors of cost included sex (mean cost £549 lower in females), SCAD diagnosis (non-ST-elevation myocardial infarction cost £656 more than stable angina), and co-morbidities (heart failure cost £657 more per patient). Compared with lower risk patients (5-year CVD risk 3.5%), those of higher risk (5-year CVD risk 44.2%) had higher 5-year costs (£23 393 vs. £9335) and lower lifetime costs (£43 020 vs. £116 888).

Conclusion: Patients with SCAD incur substantial healthcare utilization and costs, which varies and may be predicted by 5-year CVD risk profile. Higher risk patients have higher initial but lower lifetime costs than lower risk patients as a result of shorter life expectancy. Improved cardiovascular survivorship among an ageing CVD population is likely to require stratified care in anticipation of the burgeoning demand.

Keywords: Costs; Electronic health records; Resource use; Stable coronary artery disease.

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Figures

Figure 1
Figure 1
Stable coronary artery disease cohort.
Figure 2
Figure 2
Forest plot of incremental costs associated with covariates.
Figure 3
Figure 3
Expected costs and survival over time for patients representative of risk deciles 1, 4, 7, and 10. CHD, coronary heart disease; CVD, cardiovascular disease; RG, risk decile.
Figure A1
Figure A1
Forest plot of cardiovascular disease costs.
Figure A2
Figure A2
Forest plot of coronary heart disease costs.
See this image and copyright information in PMC

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