Indirect Cost Analysis and Evaluation of Factors Affecting Indirect Costs in Patients Hospitalized with Acute Coronary Syndrome in Inpatient Wards of a Training and Research Hospital

Background/Objectives: This study aims to determine the indirect costs associated with the disease process in patients hospitalized for acute coronary syndrome and to analyze the sociodemographic and clinical factors influencing these costs. Methods: This prospective, single-center, observational cost-of-illness study evaluated 146 ACS patients at a tertiary cardiology clinic over an index episode extending from admission to 30 days after discharge, from a patient and household perspective that excludes direct medical costs. Excluding six patients (one death, five early retirements), 140 patients were analyzed. Productivity losses were measured with the iMTA Productivity Cost Questionnaire and valued using the Human Capital Approach; SCORE2, GRACE and MIDAS scores were also recorded. Costs are reported in 2025 international dollars (Int$, OECD PPP factor 16.20). Factors associated with total indirect cost were examined with a Gamma generalized linear model with a log link, containing five prespecified covariates: sex, occupational group, age, GRACE and MIDAS. Results: The mean age was 61 ± 12 years, and 69.9% of the cohort were male. The median total indirect cost per patient was 1007 Int$. In the actively employed subgroup, the median absenteeism cost was 1450 Int$, while the median household production loss for the entire cohort was 340 Int$. The multivariate Gamma GLM identified occupational status (p < 0.001) and female sex (p = 0.004) as variables independently associated with total indirect costs, whereas age and clinical/prognostic scores (GRACE, MIDAS) lacked statistical significance. Compared to patients outside the labor force, total costs were 4.8 and 4.1 times higher for white-collar and blue-collar workers, respectively. Conclusions: ACS imposes a significant short-term indirect cost burden at the patient and household levels, driven by absenteeism among actively employed patients and by household production losses among those outside the labor force. These findings indicate that the early post-discharge economic burden is patterned primarily by labor force position and by the distribution of unpaid domestic work rather than by clinical severity.