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Eur Heart J Qual Care Clin Outcomes. 2016 Jan 20;2(2):125-140.

Long-term healthcare use and costs in patients with stable coronary artery disease: a population-based cohort using linked health records (CALIBER).

Author information

1
Centre for Health Economics, University of York, York YO10 5DD, UK.
2
Faculty of Medicine and Health, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK.
3
Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London WC1E 6BT, UK.
4
Department of Health Sciences, Centre for Biostatistics & Genetic Epidemiology, Leicester LE1 7RH, UK.
5
Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK.
6
NIHR Biomedical Research Unit, Barts and the London NHS Trust, London E1 2AD, UK.

Abstract

AIMS:

To examine long-term healthcare utilization and costs of patients with stable coronary artery disease (SCAD).

METHODS AND 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).

CONCLUSION:

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.

KEYWORDS:

Costs; Electronic health records; Resource use; Stable coronary artery disease

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