Costs of coronary heart disease and stroke: the case of Sweden

Objectives. To estimate the annual costs in Sweden of coronary heart diseas e (CHD) and stroke, and the potential cost savings if these clinical 'event s' are avoided. The analysis is undertaken from a societal perspective, inc luding both direct and indirect costs. Costs are calculated for five clinic al conditions: (i) acute myocardial infarction (AMI), (ii) angina pectoris (AP), (iii) unstable angina (UA), (iv) congestive heart failure (CHF), and (v) stroke. Design. A retrospective study including patients admitted to the Department of Medicine at Sodertalje Hospital during the period January 1993 to March 1995 with CHD or a stroke. Each patient was followed for 1 year after admi ssion to the hospital. To estimate potential cost savings, the patient was used as his or her own control. The potential savings in direct costs if CH D or a stroke is avoided were estimated as the difference between costs for 1 year after and 1 year before the event. The indirect costs were calculat ed as the difference between the values of market production of goods and s ervices the year before the event and the year after. Setting. The Department of Medicine at Sodertalje Hospital, Sodertalje, Swe den. Subjects. The patients included in the study were patients at the Departmen t of Medicine at Sodertalje Hospital in Sweden. The inclusion criterion was that the patients should have been admitted for the first time for CHD or stroke during the year 1994. To obtain 25 patients for each clinical catego ry we first had to expand the inclusion period to cover January 1993 to Mar ch 1995. Secondly, we also had to include 36 patients with an earlier estab lished uncomplicated CHD or stroke. Despite this, no more than 22 patients with UA were found. Interventions. Patients were followed in medical practice. Main outcome measures. Costs, direct and indirect costs, and potential savi ngs. Results. The mean direct costs during the year after a clinical event range between Swedish kronor (SEK) 41 000 for CHF and SEK 96 000 for stroke, whe reas the mean potential savings in direct costs range from SEK 36 000 for C HF to SEK 91 000 for UA. The potential mean savings in indirect costs range between SEK 24 000 for CHF and SEK 102 000 for AMI. The direct costs for f irst-time patients are lower than those for patients with an earlier establ ished CHD or stroke. No systematic differences have been found in potential direct cost savings and indirect costs between the two patient groups. Conclusions. CHD and stroke are associated with high costs during the year after admission to the Department of Medicine. There are also large potenti al cost savings from the prevention of CHD and stroke. However, further stu dies, including more patients and costs arising in the municipality, are ne eded to establish more precise and complete estimates of the costs related to CHD and stroke.