The household economic burden for acute coronary syndrome survivors in Australia.
Studies of chronic diseases are associated with a financial burden on households. We aimed to determine if survivors of acute coronary syndrome (ACS) experience household economic burden and to quantify any potential burden by examining level of economic hardship and factors associated with hardship.



Australian patients admitted to hospital with ACS during 2-week period in May 2012, enrolled in SNAPSHOT ACS audit and who were alive at 18 months after index admission were followed-up via telephone/paper survey. Regression models were used to explore factors related to out-of-pocket expenses and economic hardship.



Of 1833 eligible patients at baseline, 180 died within 18 months, and 702 patients completed the survey. Mean out-of-pocket expenditure (n = 614) in Australian dollars was A$258.06 (median: A$126.50) per month. The average spending for medical services was A$120.18 (SD: A$310.35) and medications was A$66.25 (SD: A$80.78). In total, 350 (51 %) of patients reported experiencing economic hardship, 78 (12 %) were unable to pay for medical services and 81 (12 %) could not pay for medication. Younger age (18-59 vs ≥80 years (OR): 1.89), no private health insurance (OR: 2.04), pensioner concession card (OR: 1.80), residing in more disadvantaged area (group 1 vs 5 (OR): 1.77), history of CVD (OR: 1.47) and higher out-of-pocket expenses (group 4 vs 1 (OR): 4.57) were more likely to experience hardship.



Subgroups of ACS patients are experiencing considerable economic burden in Australia. These findings provide important considerations for future policy development in terms of the cost of recommended management for patients.
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia. khyun@georgeinstitute.org.au.|, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia. khyun@georgeinstitute.org.au.
Karice K
KK
Hyun
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.|Menzies Centre for Health Policy, University of Sydney, Sydney, Australia.
Beverley M
BM
Essue
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.|Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK.
Mark
M
Woodward
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
Stephen
S
Jan
Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
David
D
Brieger
Department of Cardiology, Flinders University, Adelaide, Australia.
Derek
D
Chew
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
Kellie
K
Nallaiah
Queensland Health, Brisbane, Australia.
Tegwen
T
Howell
School of Population Health, University of Western Australia, Perth, Australia.
Tom
T
Briffa
School of Medicine, University of Adelaide, Adelaide, Australia.
Isuru
I
Ranasinghe
South Australia Division, The Heart foundation, Adelaide, Australia.
Carolyn
C
Astley
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
Julie
J
Redfern
D054058:Acute Coronary Syndrome / Q000191:economics*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002908:Chronic Disease / Q000191:economics; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011795:Surveys and Questionnaires; D017741:Survivors
Acute coronary syndrome; Financial burden; Household economic hardship; Out-of-pocket expenditure