The Costs of Cardiorespiratory Disease Episodes in a Study of Emergency Department Use

Abstract

The first point of contact for individuals with urgent health problems is often the emergency department (ED). We recently completed a study of ED use due to cardiorespiratory conditions as part of a larger study on the health effects of air quality 1 which was motivated by the recent public health concerns over this issue. [2][3][4][5][6] Several studies have documented an association between air quality and ED visits for respiratory diseases. [7][8][9][10][11][12][13][14][15][16] Thus the emergency department served as a useful reference point from which to capture the potential health costs of cardiorespiratory disease episodes. In this paper, we describe the cost methodology used to estimate the average per person direct cost of illness for four cardiorespiratory conditions and discuss the results. METHODS Data collectionThe study design and data collection are described in detail in the companion paper. 1 Briefly, data were collected prospectively between September 1, 1994 and August 31, 1995 at the two hospital emergency departments in Saint John, New Brunswick for emergency visits that were assigned a diagnosis of asthma, chronic obstructive pulmonary disease (COPD), respiratory infections, or cardiac conditions. Follow-up was conducted using a structured telephone interview in which consenting patients were asked about the occurrence of various outcomes from the onset of their earliest symptoms until the follow-up interview. Estimates of out-of-hospital costs were based on these data.Estimates of costs for hospitalization episodes were based on inpatient utilization data abstracted from clinical records for a sample of 393 patients. These inpatient records were selected randomly after stratification for the four diagnosis groups considered. Types of utilization data captured in the record abstracts included medication, procedures, investigations, physician care and length of stay. Cost calculationThe direct cost of cardiorespiratory disease episodes included six cost categories: hospital utilization, emergency department visits, physicians visits, concomitant medication use, equipment and out-of-pocket expenses. The methodology used to calculate each cost category is as outlined below. All costs were deflated by the Price Index for all products 17 and are in 1997 Canadian dollars.Emergency Visits: The cost of emergency visits included the initial visit by the patient and any subsequent visits prior to the telephone interview. A fully allocated cost including that for all hospital-based resources and physician time was estimated.Physicians Visits: Each physician clinic visit was assumed to be a "minor assessment" and valued according to the allowed reimbursement rate as specified by BC Medical Services Agreement.

The Economic Value of Preventing Respiratory and Cardiovascular Hospitalizations

“…Anis et al (2000) and Stieb et al (2000) describe a somewhat similar survey of emergency room patients conducted in Saint John, New Brunswick. This allowed compilation of COI information that was not previously available and is not included in available hospital usage databases.…”

Economic evaluation of the benefits of reducing acute cardiorespiratory morbidity associated with air pollution

“…With respect to the cost of treatment component for this outcome, compared to the Anis et al study [27], two studies based on U.S. data reported higher costs for pneumonia [45] and congestive heart failure [46], while another from Canada revealed similar costs for asthma hospital admissions [[47], personal communication, Dr. W. Ungar, November 2002]. Estimates from the U.K. were also similar to those derived here [6].…”

“…Data were obtained for 1,772 individuals. Inpatient utilization data were also abstracted from the clinical records of 393 randomly selected patients representing the same groups of cardiorespiratory conditions, and cost of illness estimates were generated which included fully allocated costs related to hospital utilization and emergency department visits, as well as costs of physician visits, medication use, equipment, and out-of-pocket expenses [27]. We analyzed these data using stepwise ordinary least squares regression.…”

Population Health Issues in the Management of Air Quality*

“…In addition to attempting to answer specific epidemiological questions related to the role of air pollution relative to other triggers in precipitating disease episodes, this study is also attempting to measure the broad quality of life and economic impacts of the health effects of air pollution. Analyses to date confirm that outcomes such as reduced activity days, bed days, additional medication use, lost time from work and school, physician office visits, and hospital admissions commonly accompany emergency department visits, and that health care costs associated with these episodes are significant Anis et al 1999).…”