Cost of Cardiovascular Disease Event and Cardiovascular Disease Treatment-Related Complication Hospitalizations in the United States

Abstract

Background: Cardiovascular disease (CVD) is among the costliest conditions in the United States, and cost-effectiveness analyses can be used to assess economic impact and prioritize CVD treatments. We aimed to develop standardized, nationally representative CVD events and selected possible CVD treatment-related complication hospitalization costs for use in cost-effectiveness analyses.

Methods: Nationally representative costs were derived using publicly available inpatient hospital discharge data from the 2012-2018 National Inpatient Sample. Events were identified using the principal International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes. Facility charges were converted to costs using charge-to-cost ratios, and total costs were estimated by applying a published professional fee ratio. All costs are reported in 2021 US dollars. Mean costs were estimated for events overall and stratified by age, sex, and survival status at discharge. Annual costs to the US health care system were estimated by multiplying the mean annual number of events by the mean total cost per discharge.

Results: The annual mean number of hospital discharges among CVD events was the highest for heart failure (1 087 000 per year) and cerebrovascular disease (800 600 per year). The mean cost per hospital discharge was the highest for peripheral vascular disease ($33 700 [95% CI, $33 300-$34 000]) and ventricular tachycardia/ventricular fibrillation ($32 500 [95% CI, $32 100-$32 900]). Hospitalizations contributing the most to annual US health care costs were heart failure ($19 500 [95% CI, $19 300-$19 800] million) and acute myocardial infarction ($18 300, [95% CI, $18 200-$18 500] million). Acute kidney injury was the most frequent possible treatment complication (515 000 per year), and bradycardia had the highest mean hospitalization costs ($17 400 [95% CI, $17 200-$17 500]).

Conclusions: The hospitalization cost estimates and statistical code reported in the current study have the potential to increase transparency and comparability of cost-effectiveness analyses for CVD in the United States.

Keywords: cardiovascular diseases; heart failure; hospitalization; myocardial infarction; stroke.

Figure 1.

Mean cardiovascular disease event hospitalization costs over time. Abbreviations: AMI – acute myocardial infarction; Cerebrovascular – cerebrovascular disease; CHD – coronary heart disease; HF – heart failure; SCA – sudden cardiac arrest; AFib – Atrial Fibrillation; PVD – peripheral vascular disease; VT/VF – ventricular tachycardia/ventricular fibrillation

Figure 2.

Total United States healthcare costs from cardiovascular disease hospitalizations over time. Abbreviations: AMI – acute myocardial infarction; Cerebrovascular – cerebrovascular disease; CHD – coronary heart disease; HF – heart failure; SCA – sudden cardiac arrest; AFib – Atrial Fibrillation; PVD – peripheral vascular disease; VT/VF – ventricular tachycardia/ventricular fibrillation