Saving lives, money and resources: drug and CABG/PCI use after myocardial infarction in a Swedish record-linkage study.
BACKGROUND
Drug costs are increasing despite the introduction of cheaper generic drugs. The aim of the present study was to analyse the entire costs of hospital care, out-patient care, and the cost of drugs for 16 months following a myocardial infarction (MI) to see to what extent drug costs contribute to the overall costs of care.


METHODS
Diagnoses and costs for care as well as mortality data obtained from the Västra Götaland Region, Sweden, and drug costs from the Swedish Board of Health and Welfare, were merged in a computer file. Patients registered from 1 July 2005 to 30 June 2006 were followed from 28 days after an MI, with follow-up until 31 October 2006.


RESULTS
Of 4,725 patients, 711 died before the start of the study and 721 during follow-up. Higher age [hazard ratio (HR, 95%CI) = 1.06 (1.05-1.07)], previous MI [HR = 1.31 (1.13-1.53)] and diabetes mellitus [HR = 1.34 (1.13-1.58)] were associated with increased mortality, which decreased with coronary interventions: CABG/PCI [HR = 0.19 (0.14-0.27)]. In a multivariable analysis, mortality was lower for patients taking simvastatin [HR = 0.62 (0.50-0.76)] and clopidogrel [HR = 0.58 (0.46-0.74)].


CONCLUSIONS
Costs for out-patient care accounted for 25% and drugs for 5% of total costs. If patients not treated with simvastatin or clopidogrel had received these drugs, an additional 154-306 lives might have been saved. Drug costs would be higher, but total costs lower. Thus, even expensive drugs may reduce overall costs.
Wilhelmsen
Lars
L
University of Gothenburg, Gothenburg, Sweden. lars.wilhelmsen@gu.se
Welin
Lennart
L
Odén
Anders
A
Björnberg
Arne
A
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000191:economics / Q000627:therapeutic use*; D017073:Atherectomy / Q000191:economics; D017115:Catheter Ablation / Q000191:economics; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000191:economics; D003920:Diabetes Mellitus / Q000401:mortality; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics / Q000401:mortality* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use*; D013548:Sweden / Q000453:epidemiology; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000924:Anticholesteremic Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D019821:Simvastatin; D013988:Ticlopidine