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PHARMACOECONOMICS -Heather Panerson- Coronary heart disease is the leading cause of death worldwide, implicated in 7.2 million deaths annually, according to the 1997 World Health Report published by the World Health Organization.! Thus, the treatment of cardio- vascular disease imposes a large burden on most countries' healthcare budgets. At the Second Annual International Meeting of the Association for Pharmacoeconornics and Outcomes Research [PhiltuJelphia, US; April 1997], US-based researchers presented data from a number of studies evaluating the costs of treatment, and the resulting patient outcomes, for cardiovascular diseases. Given that the direct medical costs of treating coronary artery disease (CAD) are substantial, healthcare providers and payers need to consider the impact of new interventions on the cost of managing this disease. 2 New interventions for CAD must also compete with existing therapies for limited healthcare resources, commented Dr MW Russel from Medical Research International, Massachusetts, US. Decisions concerning the appropriate allocations of resources necessitate a quantification of the direct medical costs of treating CAD. Dr Russel presented data from a study that aimed to develop incidence- based estimates of the direct medical costs of CAD in the US. Costing CAD in the US A Markov model was used to assess the costs of CAD-related medical care among individuals with and without a prior history of CAD. Recently, updated Framingham Heart Study coronary risk data and national data on risk factors were incorporated into the model [see boxed text]. The Medicare Current Beneficiary Survey, conducted annually by the US Health Care Financing Administration*, was used to estimate the annual use Df health services. The US thrombolysis registry was used to determine emergency room and critical-care centre resource use. Cost estimates were event-related in that they reflected the treatment of CAD events and mrgicaVnonsurgical follow-up care within 1 year of event occurrence. These were derived from national public use databases and medical literature. The first-year event-related costs were as follows: • fatal myocardial infarction SUS 17 532 • nonfatal myocardial infarction SUS 15 540 • angina pectoris SUS2569 • unstable angina pectoris $USI2 058 • sudden fatal CAD death $US713. • The federal agency is responsible for administering the Medicare and progrrIlTll'Tll!S. t Currency not specified; assumed 10 be US dolkus 1173-832419711092-ooo51S01.()(/> AdlalntematloNiI LlmltH 1.7. All rights r.Mrwd The annual cost of maintenance care, i.e. nonacute care costs, was estimated to be $USt051. The 5- and to-year cumulative costs for individuals initially free of CAD were estimated at $US9.3 billion and $USI2.6 billion, respectively. For all patients with CAD, the costs at 1,5 and 10 years were estimated to be SUSI6.2 billion, $US71.5 billion and SUSI26.6 billion dollars, respectively. Costs of care greater in the US Professor Henry Glick from the University of Pennsylvania, US, presented data showing that the cost of treating aneurysmal subarachnoid haemorrhage was greater in the US than in Canada. 3 Professor Glick and colleagues analysed the differences between the 2 countries in resource use, costs and outcomes in a randomised clinical trial of tirilizad mesylate. Data for 194 Canadian and 683 US patients were compared. The average duration of hospital stay was 4.7 days longer in Canada than the US. However, patients treated in Canada spent 4.1 fewer days in nursing homes and rehabilitation centres than did those in the US. The average cost of care in the US was greater whether US or Canadian unit costs were used. The average cost of caret in the US was SUS 11 234 and $USI5 328 greater than in Canada, using US and Canadian unit costs, respectively. Cost difference not reflected in improved outcomes No significant differences were found in the Glasgow Outcome score, death and occurrence of vasospasm. These results remained quantitatively similar when the researchers controlled for differences in severity of illness at randomisation. The apparent differences in the durations of stay between the two countries were attributable to shifts in the sites of care rather than the differences in the number of days of care, according to Professor Glick. He noted that care in Canada is shifted away from the intensive-care units because there are fewer intensive-care beds. Justifying the additional cost of care in the US was difficult, suggested Professor Glick, given the fact that there were no differences in outcomes. Also, the initial durations of hospital stay were much shorter in the US than in Canada. Use of ACE inhibitor therapy for patients with congestive heart failure (CHF) has increased at Thomas Jefferson University Hospital in Philadelphia, US, following the publication of the AHCPR guidelines for managing patients with this condition. 4 Inpharma- 21 Jun 1997 No. 10112 5
