Advertisement
Clinical Investigation| Volume 359, ISSUE 5, P257-265, May 2020

Download started.

Ok

Estimating the Economic Burden of Acute Myocardial Infarction in the US: 12 Year National Data

Published:February 21, 2020DOI:https://doi.org/10.1016/j.amjms.2020.02.004

      ABSTRACT

      Background

      Acute myocardial infarction (AMI) carries a substantial mortality and morbidity burden. The purpose of this study is to provide annual mean cost per patient and national level estimates of direct and indirect costs (lost productivity from morbidity and premature mortality) associated with AMI.

      Methods

      Nationally representative data spanning 12 years (2003-2014) with a sample of 324,869 patients with AMI from the Medical Expenditure Panel Survey (MEPS) were analyzed. A novel 2-part model was used to examine the excess direct cost associated with AMI, controlling for covariates. To estimate lost productivity from morbidity, an adjusted Generalized Linear Model was used for the differential in wage earnings between participants with and without AMI. Lost productivity from premature mortality was estimated based on published data.

      Results

      The total annual cost of AMI in 2016 dollars was estimated to be $84.9 billion, including $29.8 billion in excess direct medical expenditures, $14.6 billion in lost productivity from morbidity and $40.5 billion in lost productivity from premature mortality between 2003 and 2014. In the adjusted regression, the overall excess direct medical expenditure of AMI was $7,076 (95% confidence interval [CI] $6,028-$8,125) higher than those without AMI. After adjustment, annual wages for patients with AMI were $10,166 (95% CI −$12,985 to −$7,347) lower and annual missed work days were 5.9 days (95% CI 3.57-8.27) higher than those without AMI.

      Conclusions

      The study finds that the economic burden of AMI is substantial, for which effective prevention could result in significant health and productivity cost savings.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Boateng S
        • Sanborn T
        Acute myocardial infarction.
        Dis Mon. 2013; 59: 83-96
        • Kochanek KD
        • Murphy SL
        • Xu JQ
        • et al.
        Deaths: final data for 2014.
        Natl Vital Stat Rep. 2016; 65: 1-121
        • Ghushchyan V
        • Nair KV
        • Page II, RL
        Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both.
        Vasc Health Risk Manag. 2015; 11: 25-34
        • Kolansky DM
        Acute coronary syndromes: morbidity, mortality and pharmacoeconomic burden.
        Am J Manag Care. 2009; 15: S36-S41
        • Hartman M
        • Martin AB
        • Espinosa N
        • et al.
        National Health Care Spending in 2016: spending and enrollment growth slow after initial coverage expansions.
        Health Aff (Millwood). 2018; 37: 150-160
        • Dieleman JL
        • Baral R
        • Birger M
        • et al.
        US spending on personal health care and public health, 1996-2013.
        JAMA. 2016; 316: 2627-2646
        • Afana M
        • Brinjikji W
        • Cloft H
        • et al.
        Hospitalization costs for acute myocardial infarction patients treated with percutaneous coronary intervention in the United States are substantially higher than Medicare payments.
        Clin Cardiol. 2015; 38: 13-19
        • Kauf TL
        • Velazquez EJ
        • Crosslin DR
        • et al.
        The cost of acute myocardial infarction in the new millennium: evidence from a multinational registry.
        Am Heart J. 2006; 151: 206-212
        • Zhou X
        • Shrestha SS
        • Luman E
        • et al.
        Medical expenditures associated with diabetes in myocardial infarction and ischemic stroke patients.
        Am J Prev Med. 2017; 53 (Supplement 2): S190-S196
      1. Agency for Healthcare Research and Quality (AHRQa). Medical expenditure panel survey. 2014 Full year consolidated data file 2016a, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h171/h171doc.pdf. Accessed August 1, 2019.

      2. Agency for Healthcare Research and Quality (AHRQb). Medical expenditure panel survey, 2014 medical conditions 2016b, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h170/h170doc.pdf. Accessed August 1, 2019.

      3. National Center for Health Statistics. Health, United States, 2009: with special feature on medical technology. Hyattsville, MS. 2010, Available at:https://www.cdc.gov/nchs/data/hus/hus09.pdf. Accessed August 1, 2019.

        • Libby AM
        • Ghushchyan V
        • McQueen RB
        • et al.
        Economic differences in direct and indirect costs between people with epilepsy and without epilepsy.
        Med Care. 2012; 50: 928-933
        • Cawley J
        • Rizzo J
        • Haas K
        The association of diabetes with job absenteeism costs among obese and morbidly obese workers.
        J Occup Environ Med. 2008; 50: 527-534
        • Bishu KG
        • Gebregziabher M
        • Dismuke CE
        • et al.
        Quantifying the incremental and aggregate cost of missed work days in adults with diabetes.
        J Gen Intern Med. 2015; 30: 1773-1779
        • D'Hoore W
        • Bouckaert A
        • Tilquin C
        Practical considerations on the use of the Charlson comorbidity index with administrative data bases.
        J Epidemiol. 1996; 49: 1429-1433
        • Manning WG
        • Mullahy J
        Estimating log models: to transform or not to transform?.
        J Health Econ. 2001; 20: 461-494
        • Belotti F
        • Deb P
        • Manning WG
        • et al.
        Twopm: two-part models.
        Stata J. 2015; 15: 3-20
        • Archer KJ
        • Lemeshow S
        Goodness-of-fit test for a logistic regression model fitted using survey sample data.
        Stata J. 2006; 6: 97-105
      4. Bureau of Labor Statistics, CPI Inflation Calculator. Available at: https://www.bls.gov/data/inflation_calculator.htm. Accessed July 10, 2019.

        • StataCorp
        Stata: Release 14. Statistical Software.
        StataCorp LP, College Station, TX2015
        • Grosse SD
        • Krueger KV
        • Mvundura M
        Economic productivity by age and sex: 2007 estimates for the United States.
        Med Care. 2009; 47: S94-103
      5. U.S. Bureau of Economic Analysis, Gross Domestic Product: Implicit Price Deflator [GDPDEF], retrieved from FRED, Federal Reserve Bank of St. Louis, Available at: https://fred.stlouisfed.org/series/GDPDEF. Accessed June 5, 2019.

        • Hoyert DL
        • Heron MP
        • Murphy SL
        • et al.
        Deaths: final data for 2003.
        Natl Vital Stat Rep. 2006; 54: 1-119
        • Miniño AM
        • Heron MP
        • Murphy SL
        • et al.
        Deaths: final data for 2004.
        Natl Vital Stat Rep. 2007; 55: 1-119
        • Kung HC
        • Hoyert DL
        • Xu JQ
        • et al.
        Deaths: final data for 2005.
        Natl Vital Stat Rep. 2008; 56: 1-120
        • Heron MP
        • Hoyert DL
        • Murphy SL
        • et al.
        Deaths: final data for 2006.
        Natl Vital Stat Rep. 2009; 57: 1-134
        • Xu JQ
        • Kochanek KD
        • Murphy SL
        • et al.
        Deaths: final data for 2007.
        Natl Vital Stat Rep. 2010; 58: 1-134
        • Miniño AM
        • Murphy SL
        • Xu JQ
        • et al.
        Deaths: final data for 2008.
        Natl Vital Stat Rep. 2011; 59: 1-126
        • Kochanek KD
        • Xu J
        • Murphy SL
        • et al.
        Deaths: final data for 2009.
        Natl Vital Stat Rep. 2011; 60: 1-116
        • Murphy SL
        • Xu JQ
        • Kochanek KD
        Deaths: final data for 2010.
        Natl Vital Stat Rep. 2013; 61: 1-117
        • Kochanek KD
        • Murphy SL
        • Xu JQ
        Deaths: final data for 2011.
        Natl Vital Stat Rep. 2015; 63: 1-117
        • Murphy SL
        • Kochanek KD
        • Xu JQ
        • et al.
        Deaths: final data for 2012.
        Natl Vital Stat Rep. 2015; 63: 1-117
        • Xu JQ
        • Murphy SL
        • Kochanek KD
        • et al.
        Deaths: final data for 2013.
        Natl Vital Stat Rep. 2016; 64: 1-118
        • Prabhakaran S
        • Ruff I
        • Bernstein RA
        Acute stroke intervention: a systematic review.
        JAMA. 2015; 313: 1451-1462
        • Heidenreich PA
        • Albert NM
        • Allen LA
        • et al.
        Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association.
        Circ Heart Fail. 2013; 6: 606-619
        • Anderson JL
        • Morrow DA
        Acute myocardial infarction.
        N Engl J Med. 2017; 376: 2053-2064
        • Kinjo K
        • Sato H
        • Nakatani D
        • et al.
        Osaka Acute Coronary Insufficiency Study (OACIS) Group. Predictors of length of hospital stay after acute myocardial infarction in Japan.
        Circ J. 2004; 68: 809-815
        • Leal MF
        • Souza NF
        • Filho H
        • et al.
        Acute myocardial infarction in elderly patients: comparative analysis of the predictors of mortality. The elderly versus the young.
        Arq Bras Cardiol. 2002; 79: 363-374
        • Fang J
        • Alderman MH
        • Keenan NL
        • et al.
        Acute myocardial infarction hospitalization in the United States, 1979 to 2005.
        Am J Med. 2010; 123: 259-266
        • Esteve-Pastor MA
        • Ruíz-Nodar JM
        • Orenes-Piñero E
        • et al.
        Temporal trends in the use of antiplatelet therapy in patients with acute coronary syndromes.
        J Cardiovasc Pharmacol Ther. 2018; 23: 57-65
        • Evanchan J
        • Donnally MR
        • Binkley P
        • et al.
        Recurrence of acute myocardial infarction in patients discharged on clopidogrel and a proton pump inhibitor after stent placement for acute myocardial infarction.
        Clin Cardiol. 2010; 33: 168-171
        • Thombs BD
        • Bass EB
        • Ford DE
        • et al.
        Prevalence of depression in survivors of acute myocardial infarction.
        J Gen Intern Med. 2006; 21: 30-38
      6. The Henry J Kaiser Family Foundation. The uninsured: a primer. Key Facts about Health Insurance on the Eve Health Reform, 2016. Available at:https://kaiserfamilyfoundation.files.wordpress.com/2013/10/7451-09-the-uninsured-a-primer-key-facts-about-health-insurance.pdf. Accessed June 5, 2019.

        • Hartman M
        • Martin AB
        • Espinosa N
        • et al.
        National Health Care Spending in 2016: spending and enrollment growth slow after initial coverage expansions.
        Health Aff (Millwood). 2018; 37: 150-160
        • Mozaffarian D
        • Benjamin EJ
        • Go AS
        • et al.
        Executive summary: heart disease and stroke statistics–2016 update: a report from the American Heart Association.
        Circulation. 2016; 133: 447-454
        • Seo H
        • Yoon S-J
        • Yoon J
        • Kim D
        • et al.
        Recent trends in economic burden of acute myocardial infarction in South Korea.
        PLoS One. 2015; 10e0117446https://doi.org/10.1371/journal.pone.0117446
        • Kim A
        • Yoon SJ
        • Kim YA
        • et al.
        The burden of acute myocardial infarction after a regional cardiovascular center project in Korea.
        Int J Qual Health Care. 2015; 27: 349-355
        • Mark DB
        • Hlatky MA
        • Califf RM
        • et al.
        Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction.
        N Engl J Med. 1995; 332: 1418-1424
        • Naidoo B
        • Stevens W
        • McPherson K
        Modelling the short term consequences of smoking cessation in England on the hospitalisation rates for acute myocardial infarction and stroke.
        Tob Control. 2000; 9: 397-400
        • Zeng W
        • Stason WB
        • Fournier S
        • et al.
        Benefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries.
        Am Heart J. 2013; 165: 785-792
        • Rahimi AR
        • Spertus JA
        • Reid KJ
        • et al.
        Financial barriers to health care and outcomes after acute myocardial infarction.
        JAMA. 2007; 297: 1063-1072