title: The trade-off between costs and outcomes: the case of acute myocardial infarction.
abstract: OBJECTIVE
  To investigate and to quantify the relationship between hospital costs and health outcomes for patients with acute myocardial infarction (AMI) in Veterans Health Administration (VHA) hospitals using individual-level data for costs and outcomes.
  
  
  METHODS
  VHA administrative files for the fiscal years 2000-2006.
  
  
  METHODS
  Costs were defined as costs incurred during the index hospitalization for treatment of AMI. Mortality and readmission, assessed 1 year after the index hospitalization, were used as measures of clinical outcome. We examined health outcomes as a function of costs and other patient-level and hospital-level characteristics using a two-stage Cox proportional hazard model that accounted for competing risks within a multilevel framework. To control for patient comorbidities, we compiled a comprehensive list of comorbidities that have been found in other studies to affect mortality and readmissions.
  
  
  RESULTS
  We found that costs were negatively associated with mortality and readmissions. Every U.S.$100 less spent is associated with a 0.63 percent increase in the hazard of dying and a 1.24 percent increase in the hazard to be readmitted conditional on not dying. This main finding remained unchanged after a number of sensitivity checks.
  
  
  CONCLUSIONS
  Our results suggest that there is a trade-off between costs and outcomes. The negative association between costs and mortality suggests that outcomes should be monitored closely when introducing cost-containment programs. Additional studies are needed to examine the cost-outcome relationship for conditions other than AMI to see whether our results are consistent.
authors.affiliation: Institute for Health Care Management and Health Economics, School of Business, Economics and Social Sciences, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany. jonas.schreyoegg@wiso.uni-hamburg.de
authors.forename: Jonas
authors.initials: J
authors.lastname: Schreyögg
authors.forename: Tom
authors.initials: T
authors.lastname: Stargardt
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000191:economics* / Q000628:therapy*; D017063:Outcome Assessment, Health Care
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