title: Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both.
abstract: BACKGROUND
  The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS) alone and with common cardiovascular comorbidities.
  
  
  METHODS
  A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF), ACS with heart failure (HF), and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables.
  
  
  RESULTS
  Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191) followed by ACS with HF ($32,871±2,853), ACS with AF ($25,192±2,253), and ACS only ($17,954±563). Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719-9,427), $11,297 (95% CI 5,610-16,985), and $15,761 (95% CI 4,784-26,738) higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767), when compared with patients without these conditions.
  
  
  CONCLUSIONS
  ACS imposes a significant economic burden at both the individual and society level, particularly when with comorbid AF and HF.
authors.affiliation: College of Business and Economics, American University of Armenia, Yerevan, Armenia ; Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
authors.forename: Vahram
authors.initials: V
authors.lastname: Ghushchyan
authors.affiliation: Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
authors.forename: Kavita V
authors.initials: KV
authors.lastname: Nair
authors.affiliation: Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA ; Department of Physical Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Page
mesh_terms: D000041:Absenteeism; D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D004526:Efficiency; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits; D018582:Sick Leave / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: acute coronary syndromes; comorbid atrial fibrillation; costs; heart failure