Costs of treating cardiovascular events in Germany: a systematic literature review

Schmid, Tamara

doi:10.1186/s13561-015-0063-5

Health Economics Review

Table 2 Direct medical costs of several cardiovascular diseases in Germany (2003–2013) from a healthcare provider or SHI perspective

From: Costs of treating cardiovascular events in Germany: a systematic literature review

Study	Disease	Study design	Sample size	Gender (% male)	Age (mean ± SD years)	Unit of costs	Costs in the acute phase (actual costs; % of costs in the 1st year)	2014 € Inflation adjusted costs in acute phase^a	Costs/patient in the first 6 months (actual costs; % of the costs in the 1st year)^b	2014 € Inflation adjusted costs/patient in the first 6 months^a	Costs/patient in the 1st year after event	2014 € Inflation adjusted costs/patient in the 1st year after event^a	Costs/patient in subsequent years	2014 € Inflation adjusted Costs/patient in subsequent years^a	Other costs	2014 € Inflation adjusted other costs^a	Note
Myocardial infarction and unstable angina
Stargardt 2013 [11]	MI	Retrospective claim database analysis	12,284	71.60 %	64.1	2004–2006 €	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	Hospitalization costs: 6936	Hospitalization costs: 7927	Used provider reimbursement for costs
Reinöhl 2012 [12]	AMI	Real-world scenario administrative routine data analysis (cross sectional study)	1409	n.a.	n.a.	Not stated in publication, assume year of publication 2012.	n.a.	n.a.	n.a.	n.a.	3461.82–4643.15 depending on different anticoagulant strategy used for PCI treatment	3545–4755 depending on different anticoagulant strategy used for PCI treatment	n.a.	n.a.	In-hospital costs:	In-hospital costs:	Only patients underwent PCI at high volume centers
															^aUsing UFH monotherapy: 3807.2 ± 2235.98;	^aUsing UFH monotherapy: 3899 ± 2290;
															^aUFH + glycoprotein IIb/IIIa receptor inhibitor: 4643.15 ± 4662.48;	^aUFH + glycoprotein IIb/IIIa receptor inhibitor: 4755 ± 4775;
															^aBivalirudin: 3461.82 ± 1301.96	^aBivalirudin: 3545 ± 1333
Bäumler 2012 [10]	MI	Retrospective claims data analysis	DES: 719; BMS: 719	DES: 86.20 %; BMS: 86.07 %	DES: 60.7 (11.2); BMS: 62.2 (11.0)	2005	30 day (acute) costs were 7761 for DES group and 6704 for BMS group	30 day (acute) costs were 9030 for DES group and 7800 for BMS group	n.a.	n.a.	DES: 12,713 (SD 10,753); BMS: 11,714 (SD 9967)	DES: 14,792 (SD 12,511); BMS: 13,629 (SD 11,597)	n.a.	n.a.	n.a.	n.a.	Only patients with PCI; First MI only, excluded re-infarct
Reinhold 2011 [13]	MI	Retrospective claim data analysis	15,185	57.43 %	71.1 ± 12.6	2004/2005 €	5836; 50 %	6790	9897; 80 %	11,515	12,372	14,395	n.a.	n.a.	n.a.	n.a.	Largest SHI with representative sample; excluded recurrent events
Tiemann 2008 [15]	AMI	Retrospective study using hospital administration data	n.a.	100 %	50–60	2005	3113 from SHI perspective; 2866 from hospital perspective	3622 from SHI persp.; 3335 from hospital persp.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	Selective patient group (i.e. no revascularization, no teaching hospitals)
Fuchs 2008 [16]	MI	Calculate costs based on expert interview resource utilization data/or published data and German SHI price	n.a.	n.a.	Assume 70 % over 60 years old	2005	4560	5306	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	No information on resource use estimates
Brüggenjürgen 2006 [18]	Hospitalized UA	Prospective cross-sectional study in 19 hospitals of different health care levels	407	67.1 %	65.9 (11.6)	2000–2002 €	3644 (SD 2195, 95 % CI: 3430–3858)	4442 (SD 2676, 95 % CI: 4181–4703)	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.
Brüggenjürgen 2005 [17]	MI	Calculate costs based on expert panel resource utilization data and German SHI price	n.a.	n.a.	n.a.	2004	7522; 64 %	8918	85 %	n.a.	11,672	13,838	981 during month 13–18 after the event	1163 during month 13–18 after the event	n.a.	n.a.	Expert panel stated 57 % PTCA, 7 % CABG, 7 % pacemaker, 69 % rehab
Chronic heart failure
Biermann 2012 [19]	CHF	Retrospective panel study using claims data	2,71	74.8 %	62.9 ± 13.6	2009	n.a.	n.a.	n.a.	n.a.	3150	3417	n.a.	n.a.	Inpatient care: 74 %	n.a.	Included NYHA I-IV
															Medication: 9 %;
															Rehabilitation: 9 %
															outpatient contact: 8 %
Peters-Klimm 2012 [20]	CHF	Retrospective medical chart analysis	159	73 %	68.5 ± 10.2	2004–2005 €	n.a.	n.a.	n.a.	n.a.	4792 ± 8249	5576 ± 9598	n.a.	n.a.	Total hospitalization: 3545 (8065), including HF 466 (1525), other CV-related hospitalization 2596 (7469), and other causes of hospitalization 483 (1894);	Total hospitalization: 4125 (9384), including HF 542 (1774), other CV-related hospitalization 3020 (8690), and other causes of hospitalization 562 (562);	53 % NYHA II, 45 % NYHA III; Based on a RCT regarding an innovative medical education on primary care-based patients
Peters-Klimm 2012 [20]	CHF	Retrospective medical chart analysis	159	73 %	68.5 ± 10.2	2004–2005 €	n.a.	n.a.	n.a.	n.a.	4792 ± 8249	5576 ± 9598	n.a.	n.a.	Medication: 854 (835)	Medication: 994 (972)
Peripheral artery disease
Brüggenjürgen 2005 [17]	PAD	Calculate costs based on expert panel resource utilization data and German SHI price	n.a.	n.a.	n.a.	2004	4186; 55 %	4963	2138; 28 %	2535	7674	9098	1172 during month 13–18 after the event	1390 during month 13–18 after the event	2138 for month 1–6; 1350 for month 7-12	2535 for month 1–6; 1601 for month 7–12	Only hospitalized patients included
Stroke
Abbas 2013 [21]	Ischemic Stroke	Claims data analysis	Hospital based: 1272;	28 % hospital-based, 33 % for facility	80–81 years	2007	n.a.	n.a.	n.a.	n.a.	Hospital based: 15,573; rehabilitation facility based: 15,726	Hospital based: 17,399 rehabilitation facility based: 17,570	n.a.	n.a.	n.a.	n.a.	Rehab patients only
Abbas 2013 [21]	Ischemic Stroke	Claims data analysis	Rehabilitation facility based: 2200	28 % hospital-based, 33 % for facility	80–81 years	2007	n.a.	n.a.	n.a.	n.a.			n.a.	n.a.	n.a.	n.a.	Rehab patients only
Lindig 2010 [22]	Stroke	Retrospective claim data analysis	18,106	43.6 %	73.7 ± 12.6 years	2004/2005 €	Around 50 %	n.a.	Around 80 %	n.a.	11,408	13,273	n.a.	n.a.	n.a.	n.a.	All hospitalized patients; includes hemorrhagic & ischemic strokes
Fuchs 2008 [16]	Ischemic stroke	Calculate costs based on expert interview resource utilization data/or published data and German SHI price	n.a.	n.a.	Assume 70 % over 60 years old	2005	4780	5562	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.
Kolominsky-Rabas 2006 [23]	Ischemic stroke	Retrospective cost of illness study based on a population-based longitudinal registry database and German SHI prices.	821	45 %	52 % patients were in the age group >75 years, women (76.3), men (70.6)	2004	n.a.	n.a.	n.a.	n.a.	18,517	21,954	Annual costs for subsequent 4 years were 5479/patient.	Annual costs for subsequent 4 years were 6496/patient.	n.a.	n.a.	First-year survivors after first-ever stroke
Brüggenjürgen 2005 [17]	Ischemic stroke	Calculate costs based on expert panel resource utilization data and German SHI price	n.a.	n.a.	n.a.	2004	5134; 29 %	6087	6727; 66 %	7976	17,864	21,180	5280 during month 13–18 after the event	6260 during month 13–18 after the event	6003 for months 7–12	7117 for months 7–12	Experts estimated 53 % rehab facility, 45 % inpatient rehab

Note: “Costs” in this table is limited to direct medical costs from a SHI perspective in Germany. n.a. means not available. n.r. means not relevant
^aInflation adjusted costs according to CPI: OECE statistics extracts, http://stats.oecd.org/Index.aspx?DataSetCode=MEI_CPI_WEIGHTS#, accessed on AUG 10 2015
^bThe costs incurred in the first 6 months include those incurred in the acute phase

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ISSN: 2191-1991

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