DIRECT MEDICAL COSTS OF CORONARY-ARTERY DISEASE IN THE UNITED-STATES

To generate current incidence-based estimates of the direct medical co sts of coronary artery disease (CAD) in the United States, a Markov mo del of the economic costs of CAD-related medical care was developed. R isks of initial and subsequent CAD events (sudden CAD death, fatal/non fatal acute myocardial infarction [AMI], unstable angina, and stable a ngina) were estimated using new Framingham Heart Study risk equations and population risk profiles derived from national survey data. Costs were assumed to be those related to treatment of initial and subsequen t CAD events (''event-related'') and follow-up care (''nonevent-relate d''), respectively. Cost estimates were derived primarily from nationa l public-use databases. First-year direct medical costs of treating CA D events are estimated to be $17,532 for fatal AMI, $15,540 for nonfat al AMI, $2,569 for stable angina, $12,058 for unstable angina, and $71 3 for sudden CAD death. Nonevent-related direct costs of CAD treatment are estimated to be $1,051 annually. The annual incidence of CAD in t he United States is estimated at 616,900 cases, with first-year costs of treatment totaling $5.54 billion. Five- and 10-year cumulative cost s in 1995 dollars for patients who are initially free of CAD are estim ated at $9.2 billion and $16.5 billion, respectively; for all patients with CAD, these costs are estimated to be $71.5 billion and $126.6 bi llion, respectively. The direct medical costs of CAD create a large ec onomic burden for the United States health-care system. (C) 1998 by Ex cerpta Medica, Inc.