One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database

Objective: Acute coronary syndromes (ACS) are life-threatening disorders requiring intensive medical management or invasive cardiovascular procedures. Limited data exist on the costs and resource utilization associated with ACS. Methods: This retrospective single-cohort study analyzed administrative claims data from employer-sponsored plans for patients with an ACS hospitalization in 2001-2002. A 1-year follow-up period was used, and patients who were under age 35 or had an ACS diagnosis in the 12 months before the hospitalization were excluded. Costs were reported in 2005 US dollars. Results: We identified 16 321 patients hospitalized for ACS during the study period. Mean (+/- SD) age was 55.6 (+/- 6.7) years, 66.7% were male, and 46.3% underwent a revascularization procedure during their initial hospitalization. Mean length of stay for the initial hospitalization was 4.6 days (median: 3.0; IQR: 2.0-5.0), and per-patient expenditures averaged $22 921 (median: $13 960; IQR: $6839-28 588). During the follow-up period, 21% of patients were rehospitalized for ischemic heart disease (IHD), and the cost of rehospitalization averaged $28 637. Additionally, in the year following the inpatient admission, 50% of patients were prescribed antiplatelet or anticoagulant medications, and 90% of patients were prescribed lipid-lowering, antihypertensive, or antiarrhythmic medications. IHD-related expenditures after the initial inpatient stay averaged $9425 (median: $2800; IQR: $899-7577); 61% of these costs were due to rehospitalization. Total first-year costs averaged $32 345 (median: $21653; IQR: $10 642-41106). Limitations: Diagnoses could not be verified through medical charts. Payments for Medicare patients were not assessed given our focus on the working-age population. Conclusions: In this employer-sponsored health plan population, the costs of inpatient and outpatient IHD-related care were high. Future studies should evaluate the impact of improved patient management on post-discharge costs.