Acute coronary syndromes in Europe: 1-year costs and outcomes.
OBJECTIVE
This study aims to estimate costs (including medications prescribed, intervention rates and hospital utilization) and health outcomes of acute coronary syndromes (ACS) during the first year following diagnosis.


METHODS
Treatment pathways for ACS patients were developed and country-specific resource use was multiplied by unit costs. Countries examined were the United Kingdom (UK), France, Germany, Italy and Spain. Patients with unstable angina and acute myocardial infarction (ST-segment elevation and non-ST-segment elevation with/without Q-wave) were considered. The study models the incidence of ACS, 1-year mortality, investigations, revascularisation, pharmaceutical use and medical management. Economic outcomes were direct healthcare costs (in 2004 Euros), including total cost, cost per patient with ACS and cost per capita.


RESULTS
The estimated number of deaths in the first year following ACS diagnosis ranged from around 22 500 in Spain to over 90 000 in Germany. The largest contributors to total costs are hospital stay and revascularisation procedures. Pharmaceuticals were estimated at 14-25% of ACS total cost. The total cost of ACS in the UK is estimated around 1.9 billion Euros, compared with 1.3 billion Euros in France, 3.3 billion Euros in Germany, 3.1 billion Euros in Italy and 1.0 billion Euros in Spain. The cost per ACS patient ranges from 7009 Euros (in the UK) to 12,086 Euros (Italy).


CONCLUSIONS
Countries with higher expenditure on ACS patients tended to have lower case-fatality rates, and countries with the lowest incidence of ACS also had the lowest cost per capita. The costs of ACS constitute a large proportion of total healthcare expenditure of Western European economies.
Taylor
Matthew J
MJ
York Health Economics Consortium Ltd, University of York, UK. mt25@york.ac.uk
Scuffham
Paul A
PA
McCollam
Patrick L
PL
Newby
David E
DE
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000175:diagnosis / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000401:mortality; D002423:Cause of Death; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000191:economics / Q000401:mortality; D017281:Cost of Illness; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D011336:Probability; D011787:Quality of Health Care; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome