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Social and Economic Costs and Health-Related Quality of Life in Patients With Acute Coronary Syndrome. Value Health Reg Issues 2021; 24:123-129. [PMID: 33571726 DOI: 10.1016/j.vhri.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/18/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Health-related quality of life (HRQOL) evaluation is an important measure of the impact of certain inerventions, epecially coronary artery diseases treatments. As more patients with acute coronary syndrome (ACS) live longer, doctors and researchers want to know how they manage in day-to-day life. The aim of this study was to compare costs and HRQOL of patients who underwent percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and medical therapy (MT) and to assess its main determinants in the whole sample of patients with ACS for a period of 12 months. METHODS The study was carried out to estimate costs and HRQOL evaluation of 310 patients who underwent coronary revascularization (PCI, n = 139; CABG, n = 128; and MT, n = 43). We estimated direct costs (medical costs and nonmedical costs) and indirect costs (productivity losses owing to morbidity and mortality) based on a societal perspective, and HRQOL was assessed using the EQ-5D-3L (5 dimensions and 3 levels) and visual analog scale (VAS). We applied costs and HRQOL 1 month before treatment and 12 months after treatment in 3 groups, and scores were compared. Data entry and analysis were performed with SPSS. RESULTS Total EQ-5D index scores in PCI, CABG, and MT groups 1 month before treatment were 0.54 ± 0.26, 0.52 ± 0.25, and 0.56 ± 0.25, respectively. After 12 months, the HRQOL mean changed to 0.67 ± 0.20, 0.74 ± 0.15, and 0.65 ± 0.19, respectively, in PCI, CABG, and MT groups. The mean EQ-5D VAS score 1 month before treatment was 63 ± 15.4 for the PCI group, 62 ± 16.4 for the CABG group, and 64 ± 18.4 for the MT group; the mean EQ-5D VAS score 12 months after treatment was 74.8 ± 19.5 for the PCI group, 78.8 ± 18 for the CABG group, and 74 ± 19.7 for the MT group. All the 3 therapeutic strategies presented significant improvement in all dimensions of the follow-up. However, the CABG group was the one that had significantly greater improvement compared with PCI and MT. The mean (95% confidence interval) annual total cost for the overall sample was found to be $4940/patient. This cost was significantly higher among patients with CABG ($7327/patient) compared with PCI ($5225/patient) and MT ($2278/patient). Direct costs accounted for 87.7% and indirect costs for 12.3% of the total costs. CONCLUSION The quality of life was better in both CABG and PCI groups compared with MT after 1 year of follow-up. However, treatment with CABG is more difficult and expensive than PCI and MT, but it provides a better quality of life. The findings of the present study indicate the high economic burden of ACS in Iran.
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Costa J, Alarcão J, Amaral-Silva A, Araújo F, Ascenção R, Caldeira D, Cardoso MF, Correia M, Fiorentino F, Gavina C, Gil V, Gouveia M, Lourenço F, Mello E Silva A, Mendes Pedro L, Morais J, Vaz-Carneiro A, Veríssimo MT, Borges M. Atherosclerosis: The cost of illness in Portugal. Rev Port Cardiol 2021; 40:409-419. [PMID: 34274081 DOI: 10.1016/j.repce.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. METHODS Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. RESULTS The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). CONCLUSIONS Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.
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Affiliation(s)
- João Costa
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Alarcão
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Alexandre Amaral-Silva
- Unidade de AVC, Unidade de Neurologia, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal; Serviço de Neurologia, Hospitais CUF Descobertas, CUF Santarém e CUF Torres Vedras, Portugal
| | | | - Raquel Ascenção
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Medicina Preventiva, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Marta Ferreira Cardoso
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Manuel Correia
- Serviço de Neurologia, Centro Hospitalar Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Francesca Fiorentino
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Cristina Gavina
- Serviço de Cardiologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal; Unidade de Investigação Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Victor Gil
- Unidade Cardiovascular, Hospital dos Lusíadas, Lisboa, Portugal; Departamento de Medicina, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Miguel Gouveia
- Católica Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Francisco Lourenço
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | - Luís Mendes Pedro
- Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Serviço de Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cirurgia Vascular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João Morais
- Serviço de Cardiologia, Centro Hospitalar de Leiria, Leiria, Portugal
| | - António Vaz-Carneiro
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Saúde Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Manuel Teixeira Veríssimo
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Margarida Borges
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Unidade de Farmacologia Clínica, Centro Hospitalar Lisboa Central EPE, Lisboa, Portugal
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Gordois AL, Toth PP, Quek RG, Proudfoot EM, Paoli CJ, Gandra SR. Productivity losses associated with cardiovascular disease: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:759-769. [PMID: 27831848 DOI: 10.1080/14737167.2016.1259571] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION People with cardiovascular disease (CVD) often require time off work to recover from illness or surgery; for example, following a myocardial infarction (MI) or stroke. These individuals incur income losses, work-related productivity is reduced for employers, and output is reduced for the wider economy. Productivity impacts to the economy also arise due to CVD-related mortality. Areas covered: A systematic literature review was conducted to identify and collate studies that report the magnitude of work-related productivity losses associated with CVD generally or specific cardiovascular (CV) events or conditions (coronary heart disease, MI, stroke, transient ischemic attack, angina, heart failure, peripheral artery disease, coronary revascularization). The search was conducted using Medline, Embase, the Cochrane Library, and Google to find studies published from January 2004 to January 2015. In total, 60 studies were identified, including 20 studies conducted in the USA, 25 studies conducted in Europe, and 18 studies conducted in other countries (three studies were conducted in multiple regions). The studies differed by the scope of losses assessed (absenteeism, presenteeism, early retirement, premature mortality) and CVD conditions/events included. Studies reported either average patient or population losses, and generally used a human capital rather than friction cost method. Outcomes were standardized and adjusted to 2015 US dollars where possible. Expert commentary: The review demonstrates that CVD imposes substantial morbidity- and mortality-related productivity costs. The studies identified in the review may be used to inform and populate societal economic evaluations in CVD, with the most appropriate source study being that most closely matching the context of the evaluation.
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Affiliation(s)
- Adam L Gordois
- a Covance Market Access Services Inc. , Sydney , Australia
| | - Peter P Toth
- b University of Illinois College of Medicine , Peoria , IL , USA.,c Ciccarone Center for the Prevention of Cardiovascular Disease , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Maniadakis N, Kourlaba G, Cokkinos DV, Angeli A, Kyriopoulos J. The economic burden of atherothrombosis in Greece: results from the THESIS study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:655-665. [PMID: 22777727 DOI: 10.1007/s10198-012-0412-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/05/2012] [Indexed: 06/01/2023]
Abstract
The aim of this study was to estimate the total annual cost of patients with or at risk for atherothrombosis in Greece. A multicentre, cost-of-illness study was conducted between January 2007 and December 2009. In the study, 800 patients with coronary artery disease, cerebrovascular disease, or peripheral artery disease (PAD) or multiple cardiovascular risk factors (MRF) were recruited. Direct and indirect cost data were assessed at patients' enrolment in the study, and at 6 and 12 months of follow-up. The annual total cost was €6,017/patient. This cost ranged from €10,098/patient with PAD to €1,813/patient with MRF. The annual direct health-care cost was €5,056/patient. This cost escalates from €1,623/patient with MRF to €8,697/patient with PAD. The total annual expenditures related to atherothrombosis, in Greece, were estimated to be €7.5 billion at the national level. The findings of the current study indicate the high economic burden of atherothrombosis in Greece.
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Affiliation(s)
- Nikos Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue 115 21, Athens, Greece.
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Ademi Z, Liew D, Hollingsworth B, Wolfe R, Steg GP, Bhatt DL, Reid CM. The economic implications of treating atherothrombotic disease in Australia, from the government perspective. Clin Ther 2010; 32:119-32; discussion 106-7. [PMID: 20171418 DOI: 10.1016/j.clinthera.2010.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND The management of atherothrombotic disease is responsible for a large proportion of direct medical costs in most countries, imposing a substantial financial burden on health care payers. There is limited knowledge about direct per-person medical costs using a "bottom-up" approach. OBJECTIVE This study was designed to estimate the per-person direct medical costs incurred by communitybased subjects in Australia who have or are at high risk for atherothrombotic disease. The perspective was a governmental one, at the federal level for pharmaceuticals and at the state level for hospitalizations. METHODS One-year follow-up data were obtained for Australian participants in the international REACH (Reduction of Atherothrombosis for Continued Health) Registry who were aged >or=45 years and had either established atherothrombotic disease (coronary artery disease, cerebrovascular disease, or peripheral artery disease [PAD]) or >or=3 risk factors for atherothrombotic disease. Information was extracted on the use of cardiovascular medications, hospitalizations, general practice visits, clinical pathology and imaging studies, and use of rehabilitation services. Bottom-up costing was undertaken by assigning unit costs to each health care item, based on Australian government reimbursement data for 2006-2007. Costs were estimated in Australian dollars. RESULTS Data for 2873 Australian participants in the REACH Registry were included in the analysis. Mean (SD) annual pharmaceutical costs per person were A$1388 (A$645). Mean ambulatory care costs per person were A$704 (A$492), and mean hospitalization costs were A$10,711 (A$10,494). Compared with participants with >or=3 risk factors (adjusted for age and sex), participants with 2 to 3 affected vascular territories incurred A$160 more in mean pharmaceutical costs (95% CI, 78 to 256) and A$181 more in ambulatory care costs (95% CI, 107 to 252). Mean ambulatory care costs were A$132 greater among participants with PAD only relative to those with >or=3 risk factors (95% CI, 19 to 272). Hospital costs were not significantly increased with an increasing number of affected vascular territories. The greatest difference in direct hospital costs (A$943) was between participants with PAD relative to those with >or=3 risk factors (95% CI, -564 to 3545). CONCLUSIONS From the government perspective, management of atherothrombotic disease in Australia was costly during the period studied, particularly among those with PAD only or disease affecting 2 to 3 vascular territories. Hospitalization accounted for the majority of health care expenditure associated with atherothrombotic disease, although the number of hospitalized participants was relatively small.
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Affiliation(s)
- Zanfina Ademi
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
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