Skip to main content
Erschienen in: Cardiovascular Drugs and Therapy 5/2007

01.10.2007

Determinants of Costs and the Length of Stay in Acute Coronary Syndromes: A Real Life Analysis of More Than 10 000 Patients

verfasst von: Matthias Bramkamp, Dragana Radovanovic, Paul Erne, Thomas D. Szucs

Erschienen in: Cardiovascular Drugs and Therapy | Ausgabe 5/2007

Einloggen, um Zugang zu erhalten

Abstract

Aims

The aim of this study was to investigate inpatient costs of acute coronary syndromes (ACS) in Switzerland and to assess the main cost drivers associated with this disease.

Methods and Results

We used the national multicenter registry AMIS (acute myocardial infarction in Switzerland) which includes a representative number of 65 hospitals and a total of 11.623 patient records. The following cost modules were analyzed: hospital stay, percutaneous coronary interventions (PCI) and thrombolysis. Expenses were assessed using data from official Swiss national statistical sources. Mean total costs per patient were 12.101 Euro (median 10.929 Euro; 95% CI: 1.161–27.722 Euro). The length of stay ranged from one to 129 days with a mean of 9.5 days (median 8.0 days; 95% CI: 1–23). Overall costs were independently influenced by age, gender and existent co-morbidities, e.g. cerebrovascular disease and diabetes (p < 0.0001).

Conclusion

Our study determined specific causes for the high costs associated with hospital treatment on a large representative sample. The results should highlight unnecessary expenses and help policy makers to evaluate the base case for a DRG (Diagnosis Related Groups) scenario in Switzerland. Cost weighting of the identified secondary diagnosis should be considered in the calculation and coding of a primary diagnosis for ACS.
Literatur
1.
Zurück zum Zitat Leal J, Luengo-Fernandez R, Gray A, Petersen S, Rayner M. Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J 2006;27:1610–9, Jul.PubMedCrossRef Leal J, Luengo-Fernandez R, Gray A, Petersen S, Rayner M. Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J 2006;27:1610–9, Jul.PubMedCrossRef
5.
Zurück zum Zitat Grech ED. ABC of interventional cardiology: percutaneous coronary intervention. II: the procedure. BMJ 2003;326:1137–40.PubMedCrossRef Grech ED. ABC of interventional cardiology: percutaneous coronary intervention. II: the procedure. BMJ 2003;326:1137–40.PubMedCrossRef
6.
Zurück zum Zitat Matsui K, Polanczyk CA, Gaspoz JM, Theres H, Kleber FX, Sobashima A, et al. Management of patients with acute myocardial infarction at five academic medical centers: clinical characteristics, resource utilization, and outcome. J Investig Med 1999;47:134–40.PubMed Matsui K, Polanczyk CA, Gaspoz JM, Theres H, Kleber FX, Sobashima A, et al. Management of patients with acute myocardial infarction at five academic medical centers: clinical characteristics, resource utilization, and outcome. J Investig Med 1999;47:134–40.PubMed
7.
Zurück zum Zitat Levy E, Gabriel S, Dinet J. The comparative medical costs of atherothrombotic disease in European countries. Pharmacoeconomics 2003;21:651–9.PubMedCrossRef Levy E, Gabriel S, Dinet J. The comparative medical costs of atherothrombotic disease in European countries. Pharmacoeconomics 2003;21:651–9.PubMedCrossRef
10.
Zurück zum Zitat Patel MR, Chen AY, Peterson ED, Newby LK, Pollack CV, Jr, Brindis RG, et al. Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative. Am Heart J 2006;152:641–7.PubMedCrossRef Patel MR, Chen AY, Peterson ED, Newby LK, Pollack CV, Jr, Brindis RG, et al. Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative. Am Heart J 2006;152:641–7.PubMedCrossRef
11.
Zurück zum Zitat Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002;105:310–5.PubMedCrossRef Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002;105:310–5.PubMedCrossRef
12.
Zurück zum Zitat Radovanovic D, Erne P, Schilling J, Noseda G, Gutzwiller F. Association of dyslipidemia and concomitant risk factors with in-hospital mortality in acute coronary syndrome in Switzerland. HeartDrug 2005;5:131–139. Radovanovic D, Erne P, Schilling J, Noseda G, Gutzwiller F. Association of dyslipidemia and concomitant risk factors with in-hospital mortality in acute coronary syndrome in Switzerland. HeartDrug 2005;5:131–139.
13.
Zurück zum Zitat Erhardt L, Herlitz J, Bossaert L, Halinen M, Keltai M, Koster R, et al. Task force on the management of chest pain. Eur Heart J 2002;23:1153–76.PubMedCrossRef Erhardt L, Herlitz J, Bossaert L, Halinen M, Keltai M, Koster R, et al. Task force on the management of chest pain. Eur Heart J 2002;23:1153–76.PubMedCrossRef
14.
Zurück zum Zitat Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E, et al. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2002;23:1809–40.PubMedCrossRef Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E, et al. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2002;23:1809–40.PubMedCrossRef
15.
Zurück zum Zitat Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2003;24:28–66.PubMedCrossRef Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2003;24:28–66.PubMedCrossRef
16.
Zurück zum Zitat Silber S, Albertsson P, Aviles FF, Camici PG, Colombo A, Hamm C, et al. Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the european society of cardiology. Eur Heart J 2005;26:804–47.PubMedCrossRef Silber S, Albertsson P, Aviles FF, Camici PG, Colombo A, Hamm C, et al. Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the european society of cardiology. Eur Heart J 2005;26:804–47.PubMedCrossRef
17.
Zurück zum Zitat Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit: a two year experience of 250 patients. Am J Cardiol 1967;20:457–64.PubMedCrossRef Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit: a two year experience of 250 patients. Am J Cardiol 1967;20:457–64.PubMedCrossRef
18.
Zurück zum Zitat Reed SD, Friedman JY, Gnanasakthy A, Schulman KA. Comparison of hospital costing methods in an economic evaluation of a multinational clinical trial. Int J Technol Assess Health Care 2003;19:396–406.PubMedCrossRef Reed SD, Friedman JY, Gnanasakthy A, Schulman KA. Comparison of hospital costing methods in an economic evaluation of a multinational clinical trial. Int J Technol Assess Health Care 2003;19:396–406.PubMedCrossRef
19.
Zurück zum Zitat Fassa AA, Urban P, Radovanovic D, Duvoisin N, Gaspoz JM, Stauffer JC, et al. Trends in reperfusion therapy of ST segment elevation myocardial infarction in Switzerland: six year results from a nationwide registry. Heart 2005;91:882–8.PubMedCrossRef Fassa AA, Urban P, Radovanovic D, Duvoisin N, Gaspoz JM, Stauffer JC, et al. Trends in reperfusion therapy of ST segment elevation myocardial infarction in Switzerland: six year results from a nationwide registry. Heart 2005;91:882–8.PubMedCrossRef
20.
Zurück zum Zitat Kauf TL, Velazquez EJ, Crosslin DR, Weaver WD, Diaz R, Granger CB, et al. The cost of acute myocardial infarction in the new millennium: evidence from a multinational registry. Am Heart J 2006;151:206–12.PubMedCrossRef Kauf TL, Velazquez EJ, Crosslin DR, Weaver WD, Diaz R, Granger CB, et al. The cost of acute myocardial infarction in the new millennium: evidence from a multinational registry. Am Heart J 2006;151:206–12.PubMedCrossRef
21.
Zurück zum Zitat Gandjour A, Kleinschmit F, Lauterbach KW. European comparison of costs and quality in the treatment of acute myocardial infarction (2000–2001). Eur Heart J 2002;23:858–68.PubMedCrossRef Gandjour A, Kleinschmit F, Lauterbach KW. European comparison of costs and quality in the treatment of acute myocardial infarction (2000–2001). Eur Heart J 2002;23:858–68.PubMedCrossRef
22.
Zurück zum Zitat Mark DB, Newby LK. Early hospital discharge after uncomplicated myocardial infarction: are further improvements possible? Eur Heart J 2003;24:1613–5.PubMedCrossRef Mark DB, Newby LK. Early hospital discharge after uncomplicated myocardial infarction: are further improvements possible? Eur Heart J 2003;24:1613–5.PubMedCrossRef
23.
Zurück zum Zitat Kaul P, Newby LK, Fu Y, Mark DB, Califf RM, Topol EJ, et al. International differences in evolution of early discharge after acute myocardial infarction. Lancet 2004;363:511–7.PubMedCrossRef Kaul P, Newby LK, Fu Y, Mark DB, Califf RM, Topol EJ, et al. International differences in evolution of early discharge after acute myocardial infarction. Lancet 2004;363:511–7.PubMedCrossRef
24.
Zurück zum Zitat Tricoci P, Roe MT, Mulgund J, Newby LK, Smith SC, Jr, Pollack CV, Jr, et al. Clopidogrel to treat patients with non-ST-segment elevation acute coronary syndromes after hospital discharge. Arch Intern Med 2006;166:806–11.PubMedCrossRef Tricoci P, Roe MT, Mulgund J, Newby LK, Smith SC, Jr, Pollack CV, Jr, et al. Clopidogrel to treat patients with non-ST-segment elevation acute coronary syndromes after hospital discharge. Arch Intern Med 2006;166:806–11.PubMedCrossRef
25.
Zurück zum Zitat Bramkamp M, Dedes KJ, Szucs TD. Pharmacotherapy of acute coronary syndromes: medical economics with an emphasis on clopidogrel. Cardiovasc Drugs Ther 2005;19:291–9.PubMedCrossRef Bramkamp M, Dedes KJ, Szucs TD. Pharmacotherapy of acute coronary syndromes: medical economics with an emphasis on clopidogrel. Cardiovasc Drugs Ther 2005;19:291–9.PubMedCrossRef
26.
Zurück zum Zitat Newby LK, Hasselblad V, Armstrong PW, Van de Werf F, Mark DB, White HD, et al. Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making. Eur Heart J 2003;24:182–9.PubMedCrossRef Newby LK, Hasselblad V, Armstrong PW, Van de Werf F, Mark DB, White HD, et al. Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making. Eur Heart J 2003;24:182–9.PubMedCrossRef
27.
Zurück zum Zitat Newby LK, Eisenstein EL, Califf RM, Thompson TD, Nelson CL, Peterson ED, et al. Cost effectiveness of early discharge after uncomplicated acute myocardial infarction. N Engl J Med 2000;342:749–55.PubMedCrossRef Newby LK, Eisenstein EL, Califf RM, Thompson TD, Nelson CL, Peterson ED, et al. Cost effectiveness of early discharge after uncomplicated acute myocardial infarction. N Engl J Med 2000;342:749–55.PubMedCrossRef
28.
Metadaten
Titel
Determinants of Costs and the Length of Stay in Acute Coronary Syndromes: A Real Life Analysis of More Than 10 000 Patients
verfasst von
Matthias Bramkamp
Dragana Radovanovic
Paul Erne
Thomas D. Szucs
Publikationsdatum
01.10.2007
Verlag
Springer US
Erschienen in
Cardiovascular Drugs and Therapy / Ausgabe 5/2007
Print ISSN: 0920-3206
Elektronische ISSN: 1573-7241
DOI
https://doi.org/10.1007/s10557-007-6044-0

Weitere Artikel der Ausgabe 5/2007

Cardiovascular Drugs and Therapy 5/2007 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.