Determinants of treatment costs for unstable angina

Background and aim: Unstable angina, a common serious clinical entity, is a ssociated with a high rate of complications. The aim of our study was to ev aluate treatment costs of patients with uncomplicated and complicated follo w-up in order to evaluate the economic consequences of new therapeutic stra tegies, like the introduction of GPIIb/IIIa blockers at our hospital. Methodology: All 103 patients who were admitted to the medical intensive-ca re unit of Johann Wolfgang Goethe-University Hospital, Frankfurt am Main be tween March 2, 1992 and October 31, 1997 for unstable angina of Braunwald c lass III B were enrolled in the study. Clinical events were the occurrence of refractory ischemia, nontransmural or transmural myocardial infarction o r cardiac death. The following were documented: duration of treatment in th e ICU and in the general ward, cardiac catheterizations, balloon angioplast ies (PTCA), and bypass operations. Treatment costs were calculated on the b asis of daily rates, flat rates, and special fees. Results: Following successful primary treatment, a clinical event occurred in 48 of the 103 patients, recurrent refractory ischemia in 34 patients, no ntransmural infarction in eight patients, transmural infarction in three pa tients, and death in four patients. Patients with events were significantly less likely to have had a history of PTCA (38 % vs 60 %, p < 0.05) and wer e significantly less likely to be undergoing long-term treatment with aspir in (63 % vs 80%, p < 0.05). Other sociodemographic data as well as the init ial treatment strategies were comparable. The occurrence of a complication significantly prolonged the duration of treatment in the ICU from 2.6 days (95%-CI [2.1; 3.0]) to 3.6 days (95%-CI [3.1; 4.1]) and the total duration of treatment from 7.0 days (95%-CI [5.7; 8.4]) to 12.8 days (95%-CI [9.6; 1 6.1]). The total treatment costs rose accordingly from DM 14,360 (95%-CI [1 2,360; 16,360]) to DM 26,690 (95%-CI[23,150; 30,240]). Conclusion: The data show that ischemic complications following successful primary treatment of unstable angina constitute a common problem. Such comp lications are associated with significantly more intensive treatment and si gnificantly longer hospitalization times, resulting in a near doubling of t reatment costs.