Cost of myocardial infarction to the Australian community: a prospective, multicentre survey.
BACKGROUND
in order to evaluate the cost effectiveness of preventive strategies for myocardial infarction (MI), direct cost estimates are required. However, Australian-specific cost estimates for MI are not available.


OBJECTIVE
the CosMIC (Cost of Myocardial Infarction to the Community) in Australia study was designed to determine the resource use and estimate the direct costs associated with MI in the Australian Health Care System. This information could subsequently be used in cost-effectiveness evaluations.


METHODS
a prospective, multicentre survey was undertaken to investigate the costs associated with the initial hospitalization and the 12-month sequelae for patients with a first-ever MI. During the recruitment period 312 patients with MI from ten hospitals met the eligibility criteria. Of the 141 who consented to participate and were enrolled, three were withdrawn and 138 were included in the final analysis. Detailed data were collected for 12 months after the index hospitalization from several overlapping sources. All costs were considered from the point of view of total direct cost of care, i.e. regardless of who generated or paid for the service.


RESULTS
the mean length of hospital stay for the initial acute episode was 7.4 days and the mean cost was $A10 934 (95% confidence interval [CI] 9588, 12 280) based on 2005 Australian dollars. There were 127 cardiac-related readmissions for 55 (40%) patients and the mean length of stay was 2.6 days. The mean total direct cost of an MI per patient was $A20 502 (95% CI 18 428, 22 576). The majority of the costs were for hospitalizations (initial and readmissions), which accounted for 77% of the total 12-month costs, whilst hospitalization costs for the initial acute event accounted for 53% of all costs. During the 12-month follow-up period, out-of-hospital medical service costs (Medicare Benefits Schedule services) contributed to 7% of the total costs incurred, medications 6%, ambulance costs 3% and all other outpatient services and carer costs 7%.


CONCLUSIONS
the CosMIC study addresses the significant uncertainty associated with MI cost-of-illness data in Australia by providing an estimation of direct costs associated with MI in an Australian population. These direct costs can be used to determine the cost effectiveness of prevention strategies.
Ioannides-Demos
Lisa L
LL
Preventive Medicine Unit, Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia. lisa.demos@monash.edu
Makarounas-Kirchmann
Kelly
K
Ashton
Emma
E
Stoelwinder
Johannes
J
McNeil
John J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics*; D011446:Prospective Studies