A Systematic Review of Direct Cardiovascular Event Costs: An International Perspective



There is a lack of comprehensive cost information for cardiovascular events since 2013.


A systematic review on the contemporary cost of cardiovascular events was therefore undertaken.


Methods complied with those recommended by the Cochrane Collaboration and the Centre for Reviews and Dissemination. Studies were unrestricted by language, were from 2013 to 23 December 2017, and included cost-of-illness data in adults with the following cardiovascular conditions: myocardial infarction (MI), stroke, transient ischaemic attack (TIA), heart failure (HF), unstable angina (UA), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), or peripheral artery disease (PAD). Seven electronic databases were searched, namely Embase (Ovid), MEDLINE (Ovid), MEDLINE In-Process Citations and Daily Update (Ovid), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) database, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. The included studies reported data from a variety of years (sometimes prior to 2013), so costs were inflated and converted to $US, year 2018 values, for standardization.


After de-duplication, 29,945 titles and abstracts and then 403 full papers were screened; 82 studies (88 papers) were extracted. Year 1 average cost ranges were as follows: MI ($11,970 in Sweden to $61,864 in the USA), stroke ($10,162 in Spain to $46,162 in the USA), TIA ($6049 in Sweden to $25,306 in the USA), HF ($4456 in China to $49,427 in the USA), UA ($11,237 in Sweden to $31,860 in the USA), PCI ($17,923 in Italy to $45,533 in the USA), CABG ($17,972 in the UK to $76,279 in the USA). One Swedish study reported PAD costs in a format convertible to $US, 2018 values, with a mean annual cost of $15,565.


There was considerable unexplained variation in contemporary costs for all major cardiovascular events. One emerging theme was that average costs in the USA were considerably higher than anywhere else.

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Data Availability

The data supporting the findings of this study are available within the article and its supplementary information files.


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The authors acknowledge the help of the following contributors who assisted with screening, data extraction, and/or quality assessment: Regina Leadley, Sonia Garcia Gonzalez-Moral, Frank O’Neill (formerly Amgen Inc.), and Anna Bychenkova (Amgen Inc.). Medical writing support was provided by Cathryn M. Carter (Amgen Inc.).

Author information




All of the listed authors conform to the requirements of the International Committee for Medical Journal Editors (ICMJE). SR, C-YW, SD, and NA designed the study, carried out the methodological framework, collected the data, reviewed the studies, and completed quality assessment. LS assisted in designing the study, developed and performed the original literature searches, and contributed to the writing and revision of the manuscript. SR, C-YW, and NA contributed to the writing, interpretation of the results, and revision of the manuscript. YQ, PR, JK, and KF participated in the study design, supervised the overall progress, and contributed to the interpretation of the results and revision of the manuscript. All authors read and approved the final manuscript. SR is the overall guarantor of this work.

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Correspondence to Steve Ryder.

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This study was funded by Amgen Inc. (Thousand Oaks, CA, USA).

Conflict of interest

Steve Ryder, Lisa Stirk, Nigel Armstrong, Ching-Yun Wei, and Sohan Deshpande are employees of Kleijnen Systematic Reviews (KSR) Ltd., an independent research company that was paid by Amgen Inc. to carry out this work. Jos Kleijnen is the owner of KSR Ltd. Pratik Rane and Yi Qian are employees and stock holders of Amgen Inc. Kathleen Fox serves as a consultant for Amgen Inc.

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This manuscript reports on secondary research and does not directly report research on human participants and/or animals.

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Informed consent and ethical approval were not required.

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Ryder, S., Fox, K., Rane, P. et al. A Systematic Review of Direct Cardiovascular Event Costs: An International Perspective. PharmacoEconomics 37, 895–919 (2019). https://doi.org/10.1007/s40273-019-00795-4

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