title: The cost of inpatient death associated with acute coronary syndrome.
abstract: BACKGROUND
  No studies have addressed the cost of inpatient mortality during an acute coronary syndrome (ACS) admission.
  
  
  OBJECTIVE
  Compare ACS-related length of stay (LOS), total admission cost, and total admission cost by day of discharge/death for patients who died during an inpatient admission with a matched cohort discharged alive following an ACS-related inpatient stay.
  
  
  METHODS
  Medical and pharmacy claims (2009-2012) were used to identify admissions with a primary diagnosis of ACS from patients with at least 6 months of continuous enrollment prior to an ACS admission. Patients who died during their ACS admission (deceased cohort) were matched (one-to-one) to those who survived (survived cohort) on age, sex, year of admission, Chronic Condition Index score, and prior revascularization. Mean LOS, total admission cost, and total admission cost by the day of discharge/death for the deceased cohort were compared with the survived cohort. A generalized linear model with log transformation was used to estimate the differences in the total expected incremental cost of an ACS admission and by the day of discharge/death between cohorts. A negative binomial model was used to estimate differences in the LOS between the two cohorts. Costs were inflated to 2013 dollars.
  
  
  RESULTS
  A total of 1,320 ACS claims from patients who died (n=1,320) were identified and matched to 1,319 claims from the survived patients (n=1,319). The majority were men (68%) and mean age was 56.7±6.4 years. The LOS per claim for the deceased cohort was 47% higher (adjusted incidence rate ratio: 1.47, 95% confidence interval: 1.37-1.57) compared with claims from the survived cohort. Compared with the survived cohort, the adjusted mean incremental total cost of ACS admission claims from the deceased cohort was US$43,107±US$3,927 (95% confidence interval: US$35,411-US$50,803) higher.
  
  
  CONCLUSIONS
  Despite decreasing ACS hospitalizations, the economic burden of inpatient death remains high.
authors.affiliation: Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Page
authors.affiliation: College of Business and Economics, American University of Armenia, Yerevan, Armenia, USA.
authors.forename: Vahram
authors.initials: V
authors.lastname: Ghushchyan
authors.affiliation: Milliman, Inc, Denver, CO, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Van Den Bos
authors.affiliation: Milliman, Inc, Denver, CO, USA.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Gray
authors.affiliation: AstraZeneca, US Medical Affairs, Wilmington, DE, USA.
authors.forename: Greta L
authors.initials: GL
authors.lastname: Hoetzer
authors.affiliation: AstraZeneca, US Medical Affairs, Wilmington, DE, USA.
authors.forename: Durgesh
authors.initials: D
authors.lastname: Bhandary
authors.affiliation: Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Kavita V
authors.initials: KV
authors.lastname: Nair
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D010343:Patient Admission / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: acute coronary syndrome; cost; death; health resource utilization; hospitalization