title: Medical care costs among patients with established cardiovascular disease.
abstract: OBJECTIVE
  To estimate direct medical costs among patients with established cardiovascular disease (CVD).
  
  
  METHODS
  Observational longitudinal cohort study.
  
  
  METHODS
  We identified 12,278 patients who were added to the Kaiser Permanente Northwest CVD registry from 2000 to 2005. We observed patients until they died or left the health plan or until June 30, 2008. Total direct medical costs were calculated over an individual's entire follow-up and were then annualized by dividing by the months of follow-up. We also calculated and compared age- and sex-adjusted incidence rates per 1000 person-years of secondary CVD hospitalization and all-cause mortality and a composite outcome of both.
  
  
  RESULTS
  The total mean (SD) annual direct medical costs for the entire sample were $18,953 ($39,036). With approximately 22 million US residents having prevalent CVD or stroke, this extrapolates to direct costs of more than $400 billion. Inpatient costs accounted for 42.8% of total costs (mean [SD], $8114 [$25,410]). The greatest differences in costs were found when comparing patients who did versus did not experience a secondary CVD hospitalization ($62,755 vs $13,509, P <.001). Other large differences were found in comparisons of patients with versus without diabetes ($27,258 vs $17,210), an estimated glomerular filtration rate of less than 60 mL/min/1.73 m(2) ($29,498 vs $16,326), depression ($26,681 vs $17,303), and death ($28,689 vs $17,779) (P <.001 for all).
  
  
  CONCLUSIONS
  The economic burden of providing care to patients with CVD may be substantially greater than current American Heart Association estimates. Although several comorbid conditions undoubtedly contribute to these costs, avoidance of secondary CVD hospitalization may be the key to substantially reducing healthcare consumption.
authors.affiliation: Center for Health Research, Kaiser Permanente, Portland, OR 97227-1098, USA. greg.nichols@kpchr.org
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bell
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Pedula
authors.forename: Maureen
authors.initials: M
authors.lastname: O'Keeffe-Rosetti
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D057286:Electronic Health Records; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015205:Northwestern United States / Q000453:epidemiology; D010359:Patient Readmission / Q000191:economics*; D012042:Registries; D017678:Sex Distribution; D016896:Treatment Outcome