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Key words: Acute coronary syndromes - Acute myocardial infarction - Cost of illness - Europe - Unstable angina
ABSTRACT
Objective: This study aims to estimate costs (including medications prescribed, intervention rates and hospital utilization) and health outcomes of acute coronary syndromes (ACS) during the first year following diagnosis.
Research design and methods: Treatment pathways for ACS patients were developed and country-specific resource use was multiplied by unit costs. Countries examined were the United Kingdom (UK), France, Germany, Italy and Spain. Patients with unstable angina and acute myocardial infarction (ST-segment elevation and non-ST-segment elevation with/without Q-wave) were considered. The study models the incidence of ACS, 1-year mortality, investigations, revascularisation, pharmaceutical use and medical management. Economic outcomes were direct healthcare costs (in 2004 Euros), including total cost, cost per patient with ACS and cost per capita.
Results: ne estimated number of deaths in the first year following ACS diagnosis ranged from around 22500 in Spain to over 90000 in Germany. The largest contributors to total costs are hospital stay and revascularisation procedures. Pharmaceutical were estimated at 14-25% of ACS total cost. The total cost of ACS in the UK is estimated around euro1.9 billion, compared with euro1.3 billion in France, euro3.3 billion in Germany, euro3.1 billion in Italy and euro1.0 billion in Spain. The cost per ACS patient ranges from euro7009 (in the UK) to euro12 086 (Italy).
Conclusions: Countries with higher expenditure on ACS patients tended to have lower case-fatality rates, and countries with the lowest incidence of ACS also had the lowest cost per capita. The costs of ACS constitute a large proportion of total healthcare expenditure of Western European economies.
Introduction
Acute coronary syndromes (ACS), namely unstable angina (UA) and acute myocardial infarction (AMI), (including ST-segment elevation and non-ST-segment elevation with/without Q-wave) are a major cause of morbidity and mortality in the developed world. In the UK, over 250000 cases of ACS are diagnosed each year, imposing significant costs on the National Health Service (NHS). Similar rates are experienced in other Western European countries, although rates of heart disease and treatment paths vary between nations.
The management of ACS in both the acute phase and over the remainder of life has changed considerably over the last decade, most notably with the increased...