Economic consequences of ACS-related rehospitalizations in the US

Abstract

Objective:

To examine economic consequences related to rehospitalization following initial acute coronary syndrome (ACS) treatment in United States managed care settings.

Study design:

Retrospective observational studies.

Research design and methods:

Retrospective observational studies were conducted on two managed care populations to examine medical encounter insurance claims and charges for ACS-related rehospitalizations following an index hospitalization for new onset ACS (2002–2007). All charges were adjusted to year 2007 United States Dollars (USDs).

Main outcome measures:

The main outcomes for this study were the direct charges related to ACS rehospitalizations as captured in two separate medical encounter claims databases.

Results:

Of the 11,266 ACS patients identified for analysis in the health system plan, 3588 (32%) had at least one ACS rehospitalization. Of the 97,177 ACS patients enrolled in the nationally representative managed care database, 32,578 (34%) had at least one ACS-related rehospitalization. Multivariate analyses demonstrated that coronary artery bypass graft (CABG) was the strongest predictor of increased charges during the recurrence in both populations (p < 0.0001). When controlling for length of stay (LOS) in the model, CABG remained a significant predictor of increased charges, while percutaneous coronary intervention (PCI) and stent insertion became even stronger predictors of increased charges.

Conclusions:

The costs associated with ACS-related rehospitalizations in a real-world setting are high, even when controlling for known cost drivers such as length of stay.

Key words::

• Acute coronary syndrome
• Coronary artery bypass
• Hospitalization
• Myocardial infarction

Transparency

Declaration of funding

Study funding was provided by sanofi-aventis (Bridgewater, NJ, USA) and Bristol-Myers Squibb (Plainsboro, NJ, USA).

Declaration of financial/other relationships

K.B., A.O. and R.C. have disclosed that they are employed by Analytica International which received funding from sanofi-aventis and Bristol-Myers Squibb for the research. D.M. has disclosed that she is employed by Bristol-Myers Squibb. E.M. has disclosed that he is employed by sanofi-aventis. L.L. has disclosed that she is employed by Henry Ford Health System and has received study funding from Analytica and research funding from the National Cancer Institute, Department of Defense, Centers for Disease Control and Prevention, American Cancer Society, GlaxoSmithKline and Policy Analysis Inc. J.C. has disclosed that he has received study funding from Kaleida Foundation and Bristol-Myers Squibb/sanofi-aventis; he has received research funding from several pharmaceutical companies including the study sponsors; he is a consultant to sanofi-aventis; and he is on the Speakers Bureau of Abbott, AstraZeneca, GlaxoSmithKline and sanofi-aventis.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgment

Editorial assistance was provided by Jacob M. Willet, MPH, Global Health Economics and Pricing Analytica International, New York, NY, USA.

These data were presented in part at the October 2008 American College of Clinical Pharmacy conference, Louisville, KY, USA.