title: Long-term healthcare use and costs in patients with stable coronary artery disease: a population-based cohort using linked health records (CALIBER).
abstract: OBJECTIVE
  To examine long-term healthcare utilization and costs of patients with stable coronary artery disease (SCAD).
  
  
  RESULTS
  Linked cohort study of 94 966 patients with SCAD in England, 1 January 2001 to 31 March 2010, identified from primary care, secondary care, disease, and death registries. Resource use and costs, and cost predictors by time and 5-year cardiovascular disease (CVD) risk profile were estimated using generalized linear models. Coronary heart disease hospitalizations were 20.5% in the first year and 66% in the year following a non-fatal (myocardial infarction, ischaemic or haemorrhagic stroke) event. Mean healthcare costs were £3133 per patient in the first year and £10 377 in the year following a non-fatal event. First-year predictors of cost included sex (mean cost £549 lower in females), SCAD diagnosis (non-ST-elevation myocardial infarction cost £656 more than stable angina), and co-morbidities (heart failure cost £657 more per patient). Compared with lower risk patients (5-year CVD risk 3.5%), those of higher risk (5-year CVD risk 44.2%) had higher 5-year costs (£23 393 vs. £9335) and lower lifetime costs (£43 020 vs. £116 888).
  
  
  CONCLUSIONS
  Patients with SCAD incur substantial healthcare utilization and costs, which varies and may be predicted by 5-year CVD risk profile. Higher risk patients have higher initial but lower lifetime costs than lower risk patients as a result of shorter life expectancy. Improved cardiovascular survivorship among an ageing CVD population is likely to require stratified care in anticipation of the burgeoning demand.
authors.affiliation: Centre for Health Economics, University of York, York YO10 5DD, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Walker
authors.affiliation: Centre for Health Economics, University of York, York YO10 5DD, UK.
authors.forename: Miqdad
authors.initials: M
authors.lastname: Asaria
authors.affiliation: Centre for Health Economics, University of York, York YO10 5DD, UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Manca
authors.affiliation: Centre for Health Economics, University of York, York YO10 5DD, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Palmer
authors.affiliation: Faculty of Medicine and Health, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK.
authors.forename: Chris P
authors.initials: CP
authors.lastname: Gale
authors.affiliation: Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London WC1E 6BT, UK.
authors.forename: Anoop Dinesh
authors.initials: AD
authors.lastname: Shah
authors.affiliation: Department of Health Sciences, Centre for Biostatistics & Genetic Epidemiology, Leicester LE1 7RH, UK.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Abrams
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Crowther
authors.affiliation: NIHR Biomedical Research Unit, Barts and the London NHS Trust, London E1 2AD, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Timmis
authors.affiliation: Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London WC1E 6BT, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
authors.affiliation: Centre for Health Economics, University of York, York YO10 5DD, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Sculpher
keywords: Costs; Electronic health records; Resource use; Stable coronary artery disease