葡萄牙国家医疗服务体系中急性冠脉综合征的直接经济负担——2002年至2022年的事实与趋势

Direct economic burden of acute coronary syndromes in the Portuguese National Health Service-facts and trends between 2002 and 2022.

作者信息

Madeira Francisco, Martins Carla, Viegas Susana, Timóteo Ana Teresa, Loureiro Fátima, Perelman Julian

机构信息

NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal.

Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.

出版信息

Front Public Health. 2025 Mar 18;13:1433307. doi: 10.3389/fpubh.2025.1433307. eCollection 2025.

DOI:10.3389/fpubh.2025.1433307

PMID:40171428

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11959009/

Abstract

AIM

We estimated the average direct cost per Acute Coronary Syndromes (ACS) in-patient episodes by diagnosis, namely ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), unstable angina (UA), and undetermined AMI (Acute Myocardial Infarction). We also analyzed the changes in direct costs over time between 2002 and 2022, and the total direct economic burden of ACS hospitalizations for the Portuguese National Health Service (NHS).

METHODS

We used the Portuguese Registry of Acute Coronary Syndromes (61,440 ACS hospitalizations), a cohort of people with ACS, recruited and followed from first hospitalization. A direct cost analysis was conducted. As resources, we considered health professional working hours, non-medical resources used during in-patient stays, laboratory and diagnostic tests, interventional cardiology procedures, pharmaceuticals, hospitalization-related complications, rehabilitation services, and death costs. A multivariate analysis was performed to identify the main cost determinants.

RESULTS

The average cost per ACS patient from 2002 to 2022 was 6,280.79 €. A significantly higher average cost was observed among patients diagnosed with STEMI of 3,853.26€ (95% confidence interval [CI] 3,690.87 to 4,015.65€), among NSTEMI patients of 1,308.91 € (95% CI 1,173.52 € to 1,444.30 €), and among patients who died during the hospitalization of 12,017.64€ (95% CI 11,232.21 € to 12,803.08 €). Over time, cost trends fluctuated, increasing until 2011 and then gradually decreasing until 2022, apart from 2020. Considering the total universe of 294,307 ACS-hospitalizations, the Portuguese NHS incurred a direct economic burden of 1,831 million euros over the complete period, with total annual costs averaging 87,203,851 €, representing on average 0.93% of the NHS annual health expenditure.

CONCLUSION

ACS represent a significant direct cost and economic burden for the NHS.

摘要

目的

我们按诊断类型估算了急性冠状动脉综合征（ACS）住院病例的平均直接成本，即ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死（NSTEMI）、不稳定型心绞痛（UA）以及未明确的急性心肌梗死（AMI）。我们还分析了2002年至2022年期间直接成本随时间的变化，以及葡萄牙国家医疗服务体系（NHS）中ACS住院治疗的总直接经济负担。

方法

我们使用了葡萄牙急性冠状动脉综合征登记处的数据（61440例ACS住院病例），这是一组ACS患者队列，从首次住院开始招募并进行随访。进行了直接成本分析。在资源方面，我们考虑了卫生专业人员的工作时间、住院期间使用的非医疗资源、实验室和诊断检查、介入心脏病学手术、药品、与住院相关的并发症、康复服务以及死亡成本。进行了多变量分析以确定主要成本决定因素。

结果

2002年至2022年期间，每位ACS患者的平均成本为6280.79欧元。诊断为STEMI的患者平均成本显著更高，为3853.26欧元（95%置信区间[CI]为3690.87至4015.65欧元），NSTEMI患者为1308.91欧元（95%CI为1173.52欧元至1444.30欧元）；住院期间死亡的患者为12017.64欧元（95%CI为11232.21欧元至12803.08欧元）。随着时间推移，成本趋势波动，2011年之前上升，之后除2020年外逐渐下降至2022年。考虑到294307例ACS住院病例的总体情况，葡萄牙国家医疗服务体系在整个期间承担了18.31亿欧元的直接经济负担，年度总成本平均为87203851欧元，平均占国家医疗服务体系年度卫生支出的0.93%。