Skip to main content
SpringerLink
Log in

Determinants of Costs and the Length of Stay in Acute Coronary Syndromes: A Real Life Analysis of More Than 10 000 Patients

  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Aims

The aim of this study was to investigate inpatient costs of acute coronary syndromes (ACS) in Switzerland and to assess the main cost drivers associated with this disease.

Methods and Results

We used the national multicenter registry AMIS (acute myocardial infarction in Switzerland) which includes a representative number of 65 hospitals and a total of 11.623 patient records. The following cost modules were analyzed: hospital stay, percutaneous coronary interventions (PCI) and thrombolysis. Expenses were assessed using data from official Swiss national statistical sources. Mean total costs per patient were 12.101 Euro (median 10.929 Euro; 95% CI: 1.161–27.722 Euro). The length of stay ranged from one to 129 days with a mean of 9.5 days (median 8.0 days; 95% CI: 1–23). Overall costs were independently influenced by age, gender and existent co-morbidities, e.g. cerebrovascular disease and diabetes (p < 0.0001).

Conclusion

Our study determined specific causes for the high costs associated with hospital treatment on a large representative sample. The results should highlight unnecessary expenses and help policy makers to evaluate the base case for a DRG (Diagnosis Related Groups) scenario in Switzerland. Cost weighting of the identified secondary diagnosis should be considered in the calculation and coding of a primary diagnosis for ACS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Leal J, Luengo-Fernandez R, Gray A, Petersen S, Rayner M. Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J 2006;27:1610–9, Jul.

    Article  PubMed  Google Scholar 

  2. Schweizerische Eidgenossenschaft, Bundesamt für Statistik, Junker C. Todesursachenstatistik, Ursachen der Sterblichkeit 2001 und 2002. http://www.bfs.admin.ch/bfs/portal/de/index.html (June 2006).

  3. Schweizerische Eidgenossenschaft, Bundesamt für Statistik, Perret A. Tabellen der Gesundheitsstatistik Medizinische Statistik 2004 Resultate (Standardtabellen) Neuchâtel 2006, http://www.bfs.admin.ch/bfs/portal/de/index.html (June 2006).

  4. Schweizerische Eidgenossenschaft, Bundesamt für Statistik, Gerber Y-A. Kosten und Finanzierung des Gesundheitswesens 2003 BFS Statistik der Schweiz Neuchâtel 2006. http://www.bfs.admin.ch/bfs/portal/de/index.html (June 2006).

  5. Grech ED. ABC of interventional cardiology: percutaneous coronary intervention. II: the procedure. BMJ 2003;326:1137–40.

    Article  PubMed  Google Scholar 

  6. Matsui K, Polanczyk CA, Gaspoz JM, Theres H, Kleber FX, Sobashima A, et al. Management of patients with acute myocardial infarction at five academic medical centers: clinical characteristics, resource utilization, and outcome. J Investig Med 1999;47:134–40.

    PubMed  CAS  Google Scholar 

  7. Levy E, Gabriel S, Dinet J. The comparative medical costs of atherothrombotic disease in European countries. Pharmacoeconomics 2003;21:651–9.

    Article  PubMed  Google Scholar 

  8. Schweizerische Eidgenossenschaft, Bundesamt für Statistik, Durchschnittlich angepasste Kosten pro Pflegetag im Akutbereich 1999–2003 gewichtet durch den Case Mix 2003 http://www.bfs.admin.ch/bfs/portal/de/index.html (June 2006).

  9. UBS Quotes; http://wb1.ubs.com/cache/fin/pub/gvu/quotes/markets_instruments/?locale=en_US (May 2006).

  10. Patel MR, Chen AY, Peterson ED, Newby LK, Pollack CV, Jr, Brindis RG, et al. Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative. Am Heart J 2006;152:641–7.

    Article  PubMed  Google Scholar 

  11. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002;105:310–5.

    Article  PubMed  Google Scholar 

  12. Radovanovic D, Erne P, Schilling J, Noseda G, Gutzwiller F. Association of dyslipidemia and concomitant risk factors with in-hospital mortality in acute coronary syndrome in Switzerland. HeartDrug 2005;5:131–139.

    Google Scholar 

  13. Erhardt L, Herlitz J, Bossaert L, Halinen M, Keltai M, Koster R, et al. Task force on the management of chest pain. Eur Heart J 2002;23:1153–76.

    Article  PubMed  CAS  Google Scholar 

  14. Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E, et al. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2002;23:1809–40.

    Article  PubMed  Google Scholar 

  15. Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2003;24:28–66.

    Article  PubMed  Google Scholar 

  16. Silber S, Albertsson P, Aviles FF, Camici PG, Colombo A, Hamm C, et al. Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the european society of cardiology. Eur Heart J 2005;26:804–47.

    Article  PubMed  Google Scholar 

  17. Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit: a two year experience of 250 patients. Am J Cardiol 1967;20:457–64.

    Article  PubMed  Google Scholar 

  18. Reed SD, Friedman JY, Gnanasakthy A, Schulman KA. Comparison of hospital costing methods in an economic evaluation of a multinational clinical trial. Int J Technol Assess Health Care 2003;19:396–406.

    Article  PubMed  Google Scholar 

  19. Fassa AA, Urban P, Radovanovic D, Duvoisin N, Gaspoz JM, Stauffer JC, et al. Trends in reperfusion therapy of ST segment elevation myocardial infarction in Switzerland: six year results from a nationwide registry. Heart 2005;91:882–8.

    Article  PubMed  Google Scholar 

  20. Kauf TL, Velazquez EJ, Crosslin DR, Weaver WD, Diaz R, Granger CB, et al. The cost of acute myocardial infarction in the new millennium: evidence from a multinational registry. Am Heart J 2006;151:206–12.

    Article  PubMed  Google Scholar 

  21. Gandjour A, Kleinschmit F, Lauterbach KW. European comparison of costs and quality in the treatment of acute myocardial infarction (2000–2001). Eur Heart J 2002;23:858–68.

    Article  PubMed  CAS  Google Scholar 

  22. Mark DB, Newby LK. Early hospital discharge after uncomplicated myocardial infarction: are further improvements possible? Eur Heart J 2003;24:1613–5.

    Article  PubMed  Google Scholar 

  23. Kaul P, Newby LK, Fu Y, Mark DB, Califf RM, Topol EJ, et al. International differences in evolution of early discharge after acute myocardial infarction. Lancet 2004;363:511–7.

    Article  PubMed  Google Scholar 

  24. Tricoci P, Roe MT, Mulgund J, Newby LK, Smith SC, Jr, Pollack CV, Jr, et al. Clopidogrel to treat patients with non-ST-segment elevation acute coronary syndromes after hospital discharge. Arch Intern Med 2006;166:806–11.

    Article  PubMed  CAS  Google Scholar 

  25. Bramkamp M, Dedes KJ, Szucs TD. Pharmacotherapy of acute coronary syndromes: medical economics with an emphasis on clopidogrel. Cardiovasc Drugs Ther 2005;19:291–9.

    Article  PubMed  Google Scholar 

  26. Newby LK, Hasselblad V, Armstrong PW, Van de Werf F, Mark DB, White HD, et al. Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making. Eur Heart J 2003;24:182–9.

    Article  PubMed  CAS  Google Scholar 

  27. Newby LK, Eisenstein EL, Califf RM, Thompson TD, Nelson CL, Peterson ED, et al. Cost effectiveness of early discharge after uncomplicated acute myocardial infarction. N Engl J Med 2000;342:749–55.

    Article  PubMed  CAS  Google Scholar 

  28. InEK gGmbH, German Refined—Diagnosis Related Groups, Definitionshandbuch G-DRG-Version 2007—Fassung vom 06.12.2006, http://www.g-drg.de/ (January 2007).

Download references

Acknowledgements

We like to thank Dipl. oec. Mathias Larbig for G-DRG advice, Dr. Konstantin J. Dedes for statistical support and Kenneth W. Schneider MS for proofreading the manuscript.

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University Hospital of Zurich, RAE B 40, Rämistr. 100, CH-8091, Zurich, Switzerland

    Matthias Bramkamp

  2. AMIS Plus Data Center, Institute for Social and Preventive Medicine, University of Zurich, Hirschgraben 84, CH-8001, Zürich, Switzerland

    Dragana Radovanovic

  3. Department of Cardiology, Kantonsspital Lucerne, 6000, Lucerne 16, Switzerland

    Paul Erne

  4. Institute for Social and Preventive Medicine, University of Zurich, Hirschgraben 84, CH-8001, Zürich, Switzerland

    Thomas D. Szucs

Authors
  1. Matthias Bramkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dragana Radovanovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Erne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas D. Szucs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthias Bramkamp.

Additional information

The authors state that their study complies with the Declaration of Helsinki, that the locally appointed ethics committee has approved the research protocol and that informed consent has been obtained from the subjects (or their guardians).

Paul Erne is a co-author on behalf of the AMIS Plus Investigators.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bramkamp, M., Radovanovic, D., Erne, P. et al. Determinants of Costs and the Length of Stay in Acute Coronary Syndromes: A Real Life Analysis of More Than 10 000 Patients. Cardiovasc Drugs Ther 21, 389–398 (2007). https://doi.org/10.1007/s10557-007-6044-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10557-007-6044-0

Key words

Search

Navigation