COSTS OF ACUTE MYOCARDIAL INFARCTION HOSPITALIZATIONS FOR PATIENTS AGED 18-64 YEARS IN THE UNITED STATES

Purpose: Acute myocardial infarction (AMI) remains a leading cause of death and is one of the most costly cardiac events in the United States.  Surprisingly, AMI-specific costs have not been comprehensively examined although such information is vital for policy makers and healthcare professionals to make wise decisions in resource allocations.  We estimated AMI-specific hospitalization costs by assessing the impacts of percutaneous coronary intervention (PCI), coronary artery grafting surgery (CABG), comorbidities, complications, ST-elevation status, and length of stays (LOS), after controlling for age, sex, and geographic regions.

Methods:   From the 2006-2008 MarketScan Commercial Claims and Encounters inpatient admission data, we identified 42,546 hospitalization claims with a primary diagnosis of AMI for patients aged 18 to 64 years with non-capitated health insurance plans. We identified comorbidities and complications using secondary diagnosis codes associated with these patients.  We specified various regression models to explore the relationships between the hospitalization costs and various contributing factors while controlling demographic variables.

Results:   Among all the AMI hospitalizations, more than two third were for male patients, nearly half were for patients in the south, 40% with ST-elevation, and 60% with PCI.  The average costs for AMI-hospitalizations were $29,840 ± 22,901 and increased marginally with age, and were higher for male than female patients.  The costs were lowest in Northeast ($27,624 ± 22,012) and the highest in the West ($33,790 ± 25,373).  After controlling for demographic variables, CABG and PCI had the greatest increased costs ($28,418, p<0.001; and $12,568, p<0.001, respectively), followed by complications and LOS ($4662, p<0.001; and $2939, p<0.001, respectively). STEMI patient had higher costs than NSTEMI by $1009 after controlling for all the procedures, comorbidities, and complications. Younger and male patients were more likely to have PCI and CABG, but had shorter LOS than older and female patients.  STEMI patients were more likely than NSTEMI patients to have PCI, CABG, and longer LOS.  Patients with comorbidity and complications were less likely to have PCI and CABG, but longer LOS.

Conclusions:   Hospitalization costs for AMI were high, especially among those with procedures of CABG or PCI.  The estimated cost variations and factors influencing PCI, CABG, and LOS could be used to assess cost-effectiveness of or design cost-effective AMI intervention programs.