Social and Economic Costs and Health-Related Quality of Life in Patients With Acute Coronary Syndrome

Abstract

Objectives: Health-related quality of life (HRQOL) evaluation is an important measure of the impact of certain inerventions, epecially coronary artery diseases treatments. As more patients with acute coronary syndrome (ACS) live longer, doctors and researchers want to know how they manage in day-to-day life. The aim of this study was to compare costs and HRQOL of patients who underwent percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and medical therapy (MT) and to assess its main determinants in the whole sample of patients with ACS for a period of 12 months.

Methods: The study was carried out to estimate costs and HRQOL evaluation of 310 patients who underwent coronary revascularization (PCI, n = 139; CABG, n = 128; and MT, n = 43). We estimated direct costs (medical costs and nonmedical costs) and indirect costs (productivity losses owing to morbidity and mortality) based on a societal perspective, and HRQOL was assessed using the EQ-5D-3L (5 dimensions and 3 levels) and visual analog scale (VAS). We applied costs and HRQOL 1 month before treatment and 12 months after treatment in 3 groups, and scores were compared. Data entry and analysis were performed with SPSS.

Results: Total EQ-5D index scores in PCI, CABG, and MT groups 1 month before treatment were 0.54 ± 0.26, 0.52 ± 0.25, and 0.56 ± 0.25, respectively. After 12 months, the HRQOL mean changed to 0.67 ± 0.20, 0.74 ± 0.15, and 0.65 ± 0.19, respectively, in PCI, CABG, and MT groups. The mean EQ-5D VAS score 1 month before treatment was 63 ± 15.4 for the PCI group, 62 ± 16.4 for the CABG group, and 64 ± 18.4 for the MT group; the mean EQ-5D VAS score 12 months after treatment was 74.8 ± 19.5 for the PCI group, 78.8 ± 18 for the CABG group, and 74 ± 19.7 for the MT group. All the 3 therapeutic strategies presented significant improvement in all dimensions of the follow-up. However, the CABG group was the one that had significantly greater improvement compared with PCI and MT. The mean (95% confidence interval) annual total cost for the overall sample was found to be $4940/patient. This cost was significantly higher among patients with CABG ($7327/patient) compared with PCI ($5225/patient) and MT ($2278/patient). Direct costs accounted for 87.7% and indirect costs for 12.3% of the total costs.

Conclusion: The quality of life was better in both CABG and PCI groups compared with MT after 1 year of follow-up. However, treatment with CABG is more difficult and expensive than PCI and MT, but it provides a better quality of life. The findings of the present study indicate the high economic burden of ACS in Iran.

Keywords: acute coronary syndromes; coronary artery bypass graft; cost; medical therapy; percutaneous coronary intervention; quality of life.