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

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.

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 (644 patients), surgery (366 patients), and medical therapy (805 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).

Out of 1815 patients studied, 790 patients (43.5%) experienced at least one of the following outcomes, 101 deaths (5.6%), 170 heart attacks (9.4%), 38 strokes (2.1%), 201 angioplasty (11%), 116 cases of coronary artery bypass grafting (6.4%), and 164 cases of new coronary artery involvement (9%). The frequencies of complications in the treatment subgroups were as follows: in the medical therapy group, 101 deaths (12.5%), 140 cases of SO (17.3%), and 223 cases of EO (27.7%); in the angioplasty group, 97 deaths (15%), 92 cases of SO (14.3%), and 167 cases of EO (25.9%), and in the surgical group, 38 cases of death (10.4%), 77 cases of SO (21%), and 91 cases of EO (24.9%). The probability of medical therapy for angioplasty and surgery during 8 years was 10.2% and 9.8%, respectively. Also, the probability of angioplasty for re-angioplasty and surgery was 12.3% and 4.3%, respectively, and the probability of surgery for re-angioplasty and surgery was 10.9% and 2.5%, respectively. The average cost of direct treatment (hospitalization) in the group of percutaneous coronary intervention was 148 million rials; in the group of the coronary artery bypass graft, it was 215 million rials, and in the group of medical therapy, it was 42 million rials.

Patients with coronary artery disease have a more than 43% chance of developing cardiovascular complications within 8 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.