Ghushchyan Vahram, Nair Kavita V, Page Robert L
College of Business and Economics, American University of Armenia, Yerevan, Armenia ; Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
Vasc Health Risk Manag. 2014 Dec 24;11:25-34. doi: 10.2147/VHRM.S72331. eCollection 2015.
The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS) alone and with common cardiovascular comorbidities.
A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF), ACS with heart failure (HF), and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables.
Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191) followed by ACS with HF ($32,871±2,853), ACS with AF ($25,192±2,253), and ACS only ($17,954±563). Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719-9,427), $11,297 (95% CI 5,610-16,985), and $15,761 (95% CI 4,784-26,738) higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767), when compared with patients without these conditions.
ACS imposes a significant economic burden at both the individual and society level, particularly when with comorbid AF and HF.
本研究的目的是确定单纯急性冠状动脉综合征（ACS）以及合并常见心血管疾病时的直接和间接成本。
利用1998年至2009年医疗支出面板调查进行回顾性分析。评估了四个相互排斥的队列：仅ACS、合并心房颤动（AF）的ACS、合并心力衰竭（HF）的ACS以及同时合并这两种疾病的ACS。计算了全因和心血管相关医疗保健资源利用的直接成本。间接成本通过误工天数导致的生产力损失来确定。针对每个结局进行回归分析，控制年龄、美国人口普查区域、保险覆盖范围、性别、种族、民族、教育程度、家庭收入和合并症负担。对医疗保健利用变量使用负二项回归模型。对医疗保健成本和生产力损失变量使用托比特模型。
合并AF和HF的ACS患者的总医疗保健成本最高（38,484±5,191美元），其次是合并HF的ACS（32,871±2,853美元）、合并AF的ACS（25,192±2,253美元）以及仅ACS患者（17,954±563美元）。与仅ACS队列相比，合并AF的ACS、合并HF的ACS以及合并AF和HF的ACS的平均全因调整后医疗保健成本分别高出5,073美元（95%置信区间[CI] 719 - 9,427）、11,297美元（95% CI 5,610 - 16,985）和15,761美元（95% CI 4,784 - 26,738）。与没有这些疾病的患者相比，合并或不合并AF和/或HF的ACS患者的平均工资损失达5,266美元（95% CI -7,765，-2,767）。
ACS在个体和社会层面都带来了重大经济负担，尤其是合并AF和HF时。
