INPATIENT COSTS OF CORONARY HEART DISEASE AMONG ADULTS AGED 18-64 YEARS

Purpose: Coronary heart disease (CHD) is the most common form of and costly cardiovascular disease in the United States.  Total medical costs have been estimated at $92.8 billion in 2009, and more than half of these ($54.6) were inpatient costs.  The impact of comorbidities/complications on the cost of CHD is lacking. We examined the factors influencing the inpatient costs by analyzing a patient claims dataset.

Method: From the 2005 MarketScan Commercial Claims and Encounters inpatient dataset, we identified 33,277 hospitalization claims with a primary diagnosis of CHD for patients aged 18 to 64 years with non-capitated health insurance plans; 10,188 (30%) were acute myocardial infarction (AMI).  By secondary diagnosis status, we identified four major comorbidities/complications of CHD: hypertension, diabetes, heart failure, and hyperlipidemia. Using multivariate regression analysis, we examined the impact of these comorbidities/complications on the hospitalization costs, while controlling for selected patient characteristics as well as cardiac procedures of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI).

Result: The average costs for CHD-hospitalizations were $23,484, and was $3,353 (p<0.001) higher for AMI compared to other types of CHD.  All comorbidities/complications, were associated with increased inpatient costs.  Hyperlipidemia had the biggest impact on the higher cost of AMI hospitalizations ($4,937, p<0.001) while heart failure had the biggest impact on the higher costs of CHD hospitalizations other than AMI ($4,410, p<0.001).  Compared to hospitalizations that did not involve cardiac procedures, hospitalizations using CABG and PCI procedures increased the costs by $28,506 (p<0.001) and $12,608 (p<0.001), respectively.

Conclusion: The inpatient costs for CHD are high, especially among those for AMI.  Hypertension, heart failure, and hyperlipidemia as comorbidities/complications to CHD are major factors associated with increased costs.  Cardiac procedures of CABG and PCI greatly increased the costs of CHD hospitalizations.  New strategies for comprehensive prevention and control of hypertension, heart failure, and hyperlipidemia to reduce CHD could curb hospitalizations and cardiac procedures and thereby to control the associated medical costs.