Economic Burden and Healthcare Resource Use for Thoracic Aortic Dissections and Thoracic Aortic Aneurysms-A Population-Based Cost-of-Illness Analysis

Abstract

Background Thoracic aortic dissections (TADs) and thoracic aortic aneurysms (TAAs) are resource intensive. We sought to determine economic burden and healthcare resource use to guide health policy. Methods and Results Using universal healthcare coverage data for Ontario, Canada, from 2003 to 2016, a cost-of-illness analysis was performed. From a single-payer's perspective, direct costs (hospitalization, reinterventions, readmissions, rehabilitation, extended care, home care, prescription drugs, and imaging) were assessed in 2017 Canadian dollars. Controls without TADs or TAAs were matched 10:1 on age, sex, and socioeconomic status to cases with TADs or TAAs to compare posthospital service use to the general population. Linear and spline regression were used for cost trends. Total hospital costs increased from $9 M to $20.7 M for TADs (P<0.0001) and $13 M to $18 M for TAAs (P<0.001). Costs cumulated to $587 M for 17 113 cases. Median hospital costs for TADs were $11 525 ($6102 medical, $26 896 endograft, and $30 372 surgery) with an increase over time (P=0.04). For TAAs, median costs were $16 683 ($7247 medical, $11 679 endograft, and $22 949 surgery) with a decrease over time (P=0.03). Home care was the most used posthospital service (TADs 44%, TAAs 38%), but rehabilitation had the highest median cost (TADs $11.9 M, TAAs $11 M). Men had increased median costs for indexed hospitalizations relative to women, yet women used more posthospital services with higher service costs. Conclusions Total yearly costs have increased for TADs and TAAs. Median hospital costs have increased for TADs yet decreased for TAAs. Women use posthospital healthcare services more often than men.

Keywords: aortic aneurysm; aortic dissection; cost‐of‐illness; economics; health policy; population studies; sex‐differences.

Figure 1. Flow diagram depicting the acquisition of incident cases of thoracic aortic dissections and thoracic aortic aneurysms.

CCI indicates Canadian Classification of Health Interventions; CIHI, Canadian Institute for Health Information; ICD‐10‐CA, International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada; and NEC, not elsewhere classified.

Figure 2. Index hospitalization yearly total costs for the treatment of thoracic aortic dissections and thoracic aortic aneurysms in Ontario, Canada (2003–2016; Canadian dollars).

AA indicates aortic aneurysm; and AD, aortic dissection.

Figure 3. Index hospitalization yearly median costs for the treatment of thoracic aortic dissections and thoracic aortic aneurysms in Ontario, Canada (2003–2016; Canadian dollars).

AA indicates aortic aneurysm; and AD, aortic dissection.

Figure 4. Median costs for 1 year of healthcare system resource use to treat thoracic aortic dissections and matched comparisons cohort in Ontario, Canada (2003–2016; 2017 Canadian dollars). Matched controls are matched to the “All” aortic dissection cohort.

CT indicates computed tomography; MRI, magnetic resonance imaging; and ODB, Ontario Drug Benefit Database.

Figure 5. Median costs for 1 year of healthcare system resource use to treat thoracic aortic aneurysms and a matched comparison cohort in Ontario, Canada (2003–2016; 2017 Canadian dollars).

Matched controls are matched to the “All” thoracic aortic aneurysm cohort.CT indicates computed tomography; MRI, magnetic resonance imaging; ODB, Ontario Drug Benefit Database; OMT, optimal medical therapy; Sx, surgery; and TEVAR, thoracic endovascular aortic repair.

Figure 6. Percentage of home care, rehabilitation, complex continuing care, and long‐term care services by 1 year posttreatment for thoracic aortic dissections and matched comparison cohort stratified by sex in Ontario, Canada (2003–2016).

Matched controls are matched to the “All” aortic dissection cohort.

Figure 7. Percentage of home care, rehabilitation, complex continuing care, and long‐term care services by 1 year posttreatment for thoracic aortic aneurysms and a matched comparison cohort stratified by sex in Ontario, Canada (2003–2016). Matched controls are matched to the “All” thoracic aortic aneurysm cohort.

OMT indicates optimal medical therapy; Sx, surgery; and TEVAR, thoracic endovascular aortic repair.

Figure Figure  8. Percentage of home care, rehabilitation, complex continuing care, and long‐term care services by 1 year posttreatment for thoracic aortic dissections and a matched comparison cohort stratified by age in Ontario, Canada (2003–2016).

Matched controls are matched to the “All” aortic dissection cohort.

Figure 9. Percentage of home care, rehabilitation, complex continuing care, and long‐term care services by 1 year posttreatment for thoracic aortic aneurysms and a matched comparison cohort stratified by age in Ontario, Canada (2003–2016). Matched controls are matched to the “All” thoracic aortic aneurysm cohort.

OMT indicates optimal medical therapy; Sx, surgery; and TEVAR, thoracic endovascular aortic repair.