Costs Associated with Acute Coronary Syndrome

Los Angeles—A retrospective database analysis of >37,000 claims from employees and their dependents found that patients with acute coronary syndrome (ACS) had high short-term and long-term disability and related costs that are higher or similar to other prevalent chronic conditions such as diabetes, heart failure, hypercholesterolemia, hypertension, obesity, stroke, asthma, and rheumatoid arthritis.

The mean annual healthcare costs per worker were $8170, including $7545 for hospitalizations and other medical care and $625 for prescriptions. Employees with ACS lost 60.2 days of work in the short-term and 397 days in the long-term.

Robert L. Page, PharmD, the study’s lead author and associate professor and clinical specialist at the Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, presented the results in an oral abstract session at the AHA meeting. Janssen Pharmaceuticals, Inc., funded the study.

Dr. Page said ACS is responsible for 733,000 hospital discharges each year, and 47% of patients with ACS are working adults. In the United States, ACS costs $150 billion annually and may lead to high lost productivity and financial instability.

“It carries a huge economic burden,” Dr. Page said.

Between 2010 and 2030, the prevalence of coronary heart disease is expected to increase by 16% and the costs associated with the disease are projected to increase 53%, according to AHA estimates cited by Dr. Page.

Although direct costs have been studied extensively, few researchers have examined indirect costs related to short-term and long-term disability, according to Dr. Page. In this study, the authors examined data between January 1, 2007, and December 31, 2010, using 2 databases: (1) the Integrated Benefits Institute’s Health & Productivity Benchmarking (IBI HPB) database and (2) the IMS LifeLink^™ Health Plan Claims database.

The IBI HPB contains short-term and long-term disability claims from 14 disability insurers in the United States culled from >45,000 employer disability policies. The LifeLink^™ database contains >60 million patients from >90 health plans and includes medical and pharmacy claims, demographic information, and member eligibility and enrollment.

Patients included from the IBI HPB were ≥18 years of age and had short-term and long-term disability claims. Patients from the LifeLink^™ database were included if they were ≥18 years of age with ACS and enrolled continuously for 12 months before and after the index date.

The authors calculated direct costs from the LifeLink^™ database, while indirect costs were calculated from the IPI HPB using number of disability days and published wage data from the Bureau of Labor Statistics.

Direct costs included hospitalization, emergency department visits, outpatient services, and prescription medications. Indirect costs included estimated wage losses per claim, productivity losses per disability claim, and total number of short-term and long-term disability days.

Of the >37,000 claims, >35,000 were for short-term disability and the remainder for long-term disability. In addition, 77% of the claims were from men, and mean age was approximately 53 years. The most common comorbidities were hypertension and hyperlipidemia, which were found in approximately 70% of patients.

In the short-term, the estimated lost wages per disability claim amount was $2263, while the cost of lost productivity per disability claim was $7943. In the long-term, the estimated lost wages per disability claim amount was $20,609, while the cost of lost productivity per disability claim was $52,473.

“This can be a very significant impact on both employers and employees,” Dr. Page said.

According to Dr. Page, the study had a few limitations, including possible miscoding of medical claims and missing data. Also, the IBI HPB records data per claim, not by specific beneficiary, and productivity losses are only for employees and do not include family members.