The Outcomes and Cost of Therapeutic Interventions in Cardiovascular Patients: A Case Study for Application in Cost-Effectiveness Studies

Background and Aim: Currently, cardiovascular diseases, including coronary heart disease, are one of the leading causes of death in humans worldwide. In the Eastern Mediterranean and the Middle East, including our country, cardiovascular diseases are major health and social problems, the size of which is rapidly increasing. Due to the growth of medical technologies, population growth, and lifestyle changes, studying the consequences and costs of healthcare is a critical issue in the health system. This study aimed to evaluate the outcomes and costs of revascularization interventions (angioplasty and surgery) and medical therapy in cardiovascular patients. Materials and Methods: This is a descriptive applied study. Patients after angiography and diagnosis according to the available guidelines were treated by one of the three methods of angioplasty (۶۴۴ patients), surgery (۳۶۶ patients), and medical therapy (۸۰۵ patients) in a public hospital in Iran. The data collection tool includes a questionnaire to collect demographic, clinical and cost information of patients. Quantitative variables, such as age and costs, in the form of Mean±SD, and qualitative variables, in the form of percentage and frequency, were presented and compared. The final result of the costs was in the form of average direct costs in coronary artery surgery, angioplasty, and drug therapy were extracted and reported using SPSS software. The considered complications are the occurrence of death, heart attack, and stroke as safety outcome (SO) and performing revascularization (angioplasty or coronary bypass operation) and disease progression confirmed by re-angiography as effectiveness outcome (EO). Results: Out of ۱۸۱۵ patients studied, ۷۹۰ patients (۴۳.۵%) experienced at least one of the following outcomes, ۱۰۱ deaths (۵.۶%), ۱۷۰ heart attacks (۹.۴%), ۳۸ strokes (۲.۱%), ۲۰۱ angioplasty (۱۱%), ۱۱۶ cases of coronary artery bypass grafting (۶.۴%), and ۱۶۴ cases of new coronary artery involvement (۹%). The frequencies of complications in the treatment subgroups were as follows: in the medical therapy group, ۱۰۱ deaths (۱۲.۵%), ۱۴۰ cases of SO (۱۷.۳%), and ۲۲۳ cases of EO (۲۷.۷%); in the angioplasty group, ۹۷ deaths (۱۵%), ۹۲ cases of SO (۱۴.۳%), and ۱۶۷ cases of EO (۲۵.۹%), and in the surgical group, ۳۸ cases of death (۱۰.۴%), ۷۷ cases of SO (۲۱%), and ۹۱ cases of EO (۲۴.۹%). The probability of medical therapy for angioplasty and surgery during ۸ years was ۱۰.۲% and ۹.۸%, respectively. Also, the probability of angioplasty for re-angioplasty and surgery was ۱۲.۳% and ۴.۳%, respectively, and the probability of surgery for re-angioplasty and surgery was ۱۰.۹% and ۲.۵%, respectively. The average cost of direct treatment (hospitalization) in the group of percutaneous coronary intervention was ۱۴۸ million rials; in the group of the coronary artery bypass graft, it was ۲۱۵ million rials, and in the group of medical therapy, it was ۴۲ million rials. Conclusion: Patients with coronary artery disease have a more than ۴۳% chance of developing cardiovascular complications within ۸ years after diagnosis. Patients treated with angioplasty had fewer complications. Also, surgical treatment costs are higher than the other two treatments. Cardiovascular diseases are a group of diseases with high costs and heavy economic burdens on society and the family. Health policymakers can limit the costs and outcomes of the disease by using resources efficiently and effectively by expanding screening and self-care programs.

Keywords:

Cardiovascular disease , Cost , Revascularization , Medical therapy