Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both

Figures & data

Table 1 Demographic characteristics of cohorts

Variable	No ACS, AF, or HF (n=260,317)		ACS only (n=4,054)		ACS with AF (n=283)		ACS with HF (n=307)		ACS with AF and HF (n=35)		P-value*
	Mean or %	SE	Mean or %	SE	Mean or %	SE	Mean or %	SE	Mean or %	SE
Age (years)	44.9	0.12	66.2	0.33	69.0	1.07	70.8	1.02	71.6	4.93	<0.0001
Sex
Male	48.1%	0.12%	56.9%	1.11%	51.2%	4.09%	49.9%	3.99%	64.0%	13.67%	<0.0001
Female	51.9%	0.12%	43.1%	1.11%	48.8%	4.09%	50.1%	3.99%	36.0%	13.67%	<0.0001
Region
Northeast	19.0%	0.77%	19.9%	1.15%	17.6%	3.17%	12.4%	2.85%	5.35%	3.37%	<0.0001
Midwest	22.4%	0.84%	22.8%	1.25%	26.1%	3.60%	35.9%	4.17%	11.4%	5.56%	<0.0001
South	35.8%	1.17%	38.4%	1.40%	34.7%	4.25%	33.8%	3.99%	51.4%	15.0%	<0.0001
West	22.8%	1.19%	18.8%	1.31%	21.6%	3.43%	17.9%	3.43%	31.8%	13.3%	<0.0001
Insurance coverage
Private Insurance	72.0%	0.35%	59.4%	1.17%	58.7%	3.89%	40.1%	4.07%	44.9%	10.2%	<0.0001
Public Insurance	13.7%	0.25%	35.8%	1.14%	38.6%	4.00%	56.8%	4.16%	54.6%	10.2%	<0.0001
Uninsured	14.3%	0.22%	4.90%	0.51%	2.70%	0.96%	3.14%	1.39%	0.52%	0.54%	<0.0001
Age categories
18–34 years	32.1%	0.26%	1.10%	0.21%	0.00%	0.00%	0.00%	0.00%	9.17%	8.74%	<0.0001
35–49 years	30.3%	0.21%	10.9%	0.79%	9.45%	2.33%	7.67%	2.26%	0.00%	1.00%	<0.0001
50–64 years	22.4%	0.18%	31.5%	1.08%	23.5%	3.21%	21.4%	3.15%	7.69%	4.24%	<0.0001
65–79 years	11.3%	0.17%	37.4%	1.20%	40.6%	3.95%	39.1%	4.17%	46.9%	11.6%	<0.0001
80 years and older	3.79%	0.10%	19.1%	0.97%	26.4%	3.46%	31.8%	3.99%	36.0%	12.8%	<0.0001
Race
White	81.9%	0.44%	88.5%	0.77%	93.0%	1.65%	85.6%	2.53%	99.5%	0.54%	<0.0001
Black	11.8%	0.43%	8.27%	0.64%	4.72%	1.31%	11.2%	2.17%	0.52%	0.54%	<0.0001
Native American	0.77%	0.07%	0.70%	0.20%	0.92%	0.73%	0.52%	0.33%	0.00%	0.00%	<0.0001
Other race	5.50%	0.23%	2.59%	0.37%	1.39%	0.67%	2.77%	1.38%	0.00%	0.00%	<0.0001
Ethnicity
Hispanic	12.7%	0.50%	6.01%	0.49%	6.70%	2.21%	2.17%	0.92%	0.00%	0.00%	<0.0001
Non-Hispanic	87.3%	0.50%	94.0%	0.49%	93.3%	2.21%	97.8%	0.92%	100%	0.00%	<0.0001
Comorbidity score
Mean CCI	1.36	0.01	4.21	0.07	5.18	0.21	6.01	0.27	7.31	1.27	<0.0001
Patients with 0	42.8%	0.28%	4.94%	0.49%	2.07%	0.95%	2.83%	1.31%	4.27%	4.07%	<0.0001
Patients with 1	23.5%	0.12%	7.64%	0.55%	5.14%	1.61%	4.46%	1.34%	7.89%	5.52%	<0.0001
Patients with 2	13.9%	0.11%	15.0%	0.80%	8.38%	2.00%	6.17%	1.74%	5.48%	4.06%	<0.0001
Patients with 3	8.47%	0.09%	15.5%	0.72%	12.2%	2.46%	7.78%	1.91%	2.09%	1.57%	<0.0001
Patients with 4	5.05%	0.07%	16.7%	0.72%	17.8%	2.54%	13.8%	2.86%	2.68%	2.14%	<0.0001
Patients with 5 or more	6.38%	0.11%	40.3%	1.14%	54.4%	4.04%	65.0%	3.94%	77.6%	10.6%	<0.0001
Education
No degree	17.6%	0.25%	24.3%	1.02%	21.0%	3.61%	32.9%	4.01%	46.3%	11.4%	<0.0001
High school	50.3%	0.33%	53.8%	1.20%	49.4%	4.30%	51.6%	4.47%	46.6%	10.7%	<0.0001
BA or other	24.0%	0.31%	16.9%	0.98%	24.4%	3.95%	12.8%	2.85%	7.14%	5.17%	<0.0001
MA or PhD	8.13%	0.18%	5.04%	0.59%	5.22%	1.65%	2.74%	1.96%	0.00%	0.00%	<0.0001
Family income level
Poor	10.7%	0.19%	14.0%	0.68%	15.3%	2.54%	12.2%	1.94%	9.92%	4.19%	<0.0001
Near poor	4.01%	0.08%	6.84%	0.50%	8.71%	2.31%	5.52%	1.51%	11.8%	6.42%	<0.0001
Low income	13.0%	0.16%	16.2%	0.80%	14.4%	2.59%	30.2%	3.55%	12.4%	6.77%	<0.0001
Mid income	31.0%	0.22%	31.3%	1.06%	32.2%	2.38%	29.4%	3.36%	35.6%	12.0%	<0.0001
High income	41.2%	0.43%	31.7%	1.06%	29.5%	3.63%	22.7%	3.40%	30.3%	8.21%	<0.0001

Notes:

* Means and proportions were compared across all groups. P-values were based on F statistics. Subgroups within each group are mutually exclusive.

Abbreviations: ACS, acute coronary syndromes; AF, atrial fibrillation; CCI, Chronic Condition Index; CV, cardiovascular; HF, heart failure; SE, standard error.

Table 2 Annual health care utilization and health care expenditures stratified by all-cause and cardiovascular-related*

Variable	Estimate	No ACS, AF, or HF (n=260,317)	ACS only (n=4,054)	ACS with AF (n=283)	ACS with HF (n=307)	ACS with AF and HF (n=35)
All-cause utilization
Outpatient visits (n)	Unadjusted mean ± SE	7.41±0.09	22.8±1.14	38.3±5.10	43.1±4.53	43.2±6.86
	Adjusted IRR (95% CI)	0.77 (0.70–0.84)	Referent group	1.37 (1.01–1.88)	1.51 (1.10–2.07)	2.91 (1.19–7.14)
Inpatient admissions (n)	Unadjusted mean ± SE	0.10±0.00	0.57±0.02	0.84±0.10	1.15±0.11	1.70±0.26
	Adjusted IRR (95% CI)	0.36 (0.33–0.39)	Referent group	1.25 (0.90–1.74)	1.51 (1.16–1.96)	2.79 (1.29–6.07)
Length of inpatient stay (days)	Unadjusted mean ± SE	0.53±0.01	3.19±0.15	5.22±0.83	7.68±0.89	10.1±2.27
	Adjusted IRR (95% CI)	0.29 (0.24–0.34)	Referent group	1.08 (0.68–1.72)	1.62 (1.09–2.41)	4.01 (1.61–9.97)
ER visits (n)	Unadjusted mean ± SE	0.17±0.00	0.54±0.02	0.80±0.10	0.94±0.09	1.69±0.37
	Adjusted IRR (95% CI)	0.52 (0.48–0.55)	Referent group	1.33 (1.01–1.75)	1.35 (1.06–1.71)	3.02 (1.44–6.33)
Prescriptions (n)	Unadjusted mean ± SE	10.36±0.09	41.6±0.86	57.3±2.97	75.1±4.27	77.8±9.19
	Adjusted IRR (95% CI)	0.51 (0.46–0.56)	Referent group	1.33 (0.96–1.85)	1.79 (1.29–2.5)	3.26 (1.43–7.44)
Cardiovascular-related utilization
Outpatient visits (n)	Unadjusted mean ± SE	N/A	2.17±0.13	5.33±0.74	3.90±0.38	9.30±2.06
	Adjusted IRR (95% CI)	N/A	Referent group	2.56 (2.03–3.22)	2.13 (1.72–2.64)	5.19 (3.33–8.07)
Inpatient admissions (n)	Unadjusted mean ± SE	N/A	0.22±0.01	0.35±0.05	0.58±0.08	0.88±0.22
	Adjusted IRR (95% CI)	N/A	Referent group	1.75 (1.34–2.29)	2.95 (2.29–3.81)	5.64 (3.17–10.0)
Length of inpatient stay (days)	Unadjusted mean ± SE	N/A	1.24±0.09	2.23±0.44	3.94±0.61	5.06±2.08
	Adjusted IRR (95% CI)	N/A	Referent group	1.93 (1.37–2.71)	3.57 (2.67–4.76)	4.23 (1.97–9.08)
Number of ER visits	Unadjusted mean ± SE	N/A	0.19±0.01	0.29±0.05	0.45±0.07	0.93±0.26
	Adjusted IRR (95% CI)	N/A	Referent group	1.70 (1.22–2.35)	2.79 (2.04–3.82)	6.69 (3.87–11.6)
Number of prescriptions	Unadjusted mean ± SE	2.59±0.03	16.4±0.34	24.1±1.57	30.2±1.71	31.7±5.98
	Adjusted IRR (95% CI)	N/A	Referent group	1.45 (1.25–1.67)	1.59 (1.41–1.79)	2.37 (1.25–4.48)
Total health care expenditures
All-cause ($)	Unadjusted mean ± SE	$4,200s±42	$17,954±563	$25,191±2,253	$32,871±2,853	$38,484±5,191
	Adjusted incremental cost (95% CI)	−$7,482 (−8,605–6,360)	Referent group	$5,073 (719–9,427)	$11,297 (5,610–16,985)	$15,761 (4,784–26,738)
Cardiovascular-related ($)	Unadjusted mean ± SE	$169±3	$6,194±315	$10,225±1,254	$13,314±1,958	$13,810±3,533
	Adjusted incremental cost (95% CI)	N/A	Referent group	$5,037 (2,620–7,454)	$8,606 (4,669–12,542)	$9,966 (3,176–16,756)

Notes:

* Health care expenditures were inflated to 2011 US dollar value.

Abbreviations: ACS, acute coronary syndrome; AF, atrial fibrillation; ER, emergency room; HF, heart failure; IRR, incident rate ratio; N/A, not available; SE, standard error; CI, confidence interval.

Table 3 Annual productivity costs associated with those with and without acute coronary syndromes

Variable	Estimate	No ACS, AF, or HF (n=260,317)	ACS, ACS with AF, HF, or both (n=4,679)
Employed population (full/part time for some part of year)
Missed work due to illness (days)	Unadjusted mean ± SE	4.06±0.05	13.8±1.22
	Adjusted IRR (95% CI)	Referent group	2.57 (2.10–3.16)
Adult population (aged 18–64 years)
Annual wage ($)*	Unadjusted mean ± SE	$34,000±278	$25,783±1,178
	Adjusted incremental cost (95% CI)	Referent group	−$5,266 (−7,765, −2,767)
Unemployment	Unadjusted mean ± SE	0.16±0.00	0.38±0.02
	Adjusted OR (95% CI)	Referent group	1.40 (1.21–1.63)

Note:

* Annual wage was inflated to 2011 US dollar value.

Abbreviations: ACS, acute coronary syndrome; AF, atrial fibrillation; HF, heart failure; IRR, incident rate ratio; OR, odds ratio; SE, standard error; CI, confidence interval.

Figure 1 Estimated annual lost productivity for the US population because of epilepsy and other chronic conditions. Marginal effects from generalized linear model using log link and gamma distribution adjusted for sex, race, ethnicity, region, age, insurance status, epilepsy, diabetes, depression, anxiety, asthma, hypertension, number of other chronic conditions, and survey years; wage income expressed in 2011 US dollars.

Note: Copyright © 2012. Wolters Kluwer Health. Reproduced with permission from Libby AM, Ghushchyan V, McQueen RB, Slejko JF, Bainbridge JL, Campbell JD. Economic differences in direct and indirect costs between people with epilepsy and without epilepsy. Med Care. 2012;50(11): 928–933. Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Lippincott Williams & Wilkins. Please contact [email protected] for further information.²⁵

LibbyAMGhushchyanVMcQueenRBSlejkoJFBainbridgeJLCampbellJDEconomic differences in direct and indirect costs between people with epilepsy and without epilepsyMed Care2012501192893323047781

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