Evaluation of hospitalization and follow-up care costs among patients hospitalized with ACS treated with a stent and clopidogrel

Abstract

Objective:

This retrospective claims study was performed to evaluate the initial and subsequent healthcare costs in patients with acute coronary syndrome (ACS) who had been treated with stent placement and clopidogrel following discharge from the hospital.

Method and results:

This was a retrospective, administrative claims-based analysis from a large, geographically diverse US managed care plan affiliated with i3 Innovus. Study subjects were commercially insured enrollees, aged ≥ 18, who were hospitalized for ACS between 1 January 2000 and 31 December 2004 with a stent placed, and had at least one filled prescription for clopidogrel within 7 days of discharge from the index hospitalization. Of the 9135 subjects included in the cost analysis, 2241 subjects experienced a subsequent event. On average, subjects with a second event incurred $32,495 more in medical costs over 2 years and $39,742 more in medical costs over 3 years versus those who did not have a second event. Excluding ischemic hospitalizations, subjects with a second event incurred $7257 and $9724 more in medical costs than patients without a second event during the 2 and 3 years following discharge from the index hospitalization, respectively.

Conclusions:

Significant cost increases were observed among patients who had a subsequent hospitalization for an ischemic event compared to those without a subsequent hospitalization. Cost increases were still present after excluding costs of the ischemic hospitalizations. The findings of this study must be considered within the limitations of database analysis as claims data are collected for the purpose of payment and not research.

Key words::

• Angioplasty
• Cost-benefit analysis
• Ischemia
• Myocardial infarction
• Revascularization

Transparency

Declaration of funding

Funding for this study was provided by AstraZeneca.

Declaration of financial/other relationships

B.C. and A.A.R. have disclosed that they are employed by i3 Innovus, the company that conducted this study. G.W. and O.H. have disclosed that they are employed by AstraZeneca, the company that funded this study, and own stock in AstraZeneca.

Some peer reviewers receive honoraria from CMRO for their review work. Peer reviewer 1 has disclosed that he/she has received grants from Amgen, Merck, Ipsen, and Epicopt. The other peer reviewer has no relevant financial relationships.

Acknowledgment

The authors thank Theodore Darkow, clinical pharmacist, and Victoria Porter, medical writer, at i3 Innovus, for their assistance with this manuscript.