Key result
Highest out-of-pocket costs linked to ~357% greater odds of economic hardship among ACS survivors.
Why the study?
Survivors of acute coronary syndrome may experience household economic burden, but the extent and associated factors were not well quantified in Australia.
Observational (n=702)
Yes
A significant proportion of acute coronary syndrome survivors in Australia experience considerable household economic burden and hardship, particularly younger patients and those without private health insurance.
Economic hardship affects half of ACS survivors; leaves open whether targeted financial supports mitigate risk in vulnerable subgroups.
BACKGROUND: Studies of chronic diseases are associated with a financial burden on households. We aimed to determine if survivors of acute coronary syndrome (ACS) experience household economic burden and to quantify any potential burden by examining level of economic hardship and factors associated with hardship. METHODS: Australian patients admitted to hospital with ACS during 2-week period in May 2012, enrolled in SNAPSHOT ACS audit and who were alive at 18 months after index admission were followed-up via telephone/paper survey. Regression models were used to explore factors related to out-of-pocket expenses and economic hardship. RESULTS: Of 1833 eligible patients at baseline, 180 died within 18 months, and 702 patients completed the survey. Mean out-of-pocket expenditure (n = 614) in Australian dollars was A$258.06 (median: A$126.50) per month. The average spending for medical services was A$120.18 (SD: A$310.35) and medications was A$66.25 (SD: A$80.78). In total, 350 (51 %) of patients reported experiencing economic hardship, 78 (12 %) were unable to pay for medical services and 81 (12 %) could not pay for medication. Younger age (18-59 vs ≥80 years (OR): 1.89), no private health insurance (OR: 2.04), pensioner concession card (OR: 1.80), residing in more disadvantaged area (group 1 vs 5 (OR): 1.77), history of CVD (OR: 1.47) and higher out-of-pocket expenses (group 4 vs 1 (OR): 4.57) were more likely to experience hardship. CONCLUSION: Subgroups of ACS patients are experiencing considerable economic burden in Australia. These findings provide important considerations for future policy development in terms of the cost of recommended management for patients.
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Hyun et al. (2016) conducted an observational in Acute coronary syndrome (n=702). Highest quartile of out-of-pocket expenditure vs. Lowest quartile of out-of-pocket expenditure was evaluated on Household economic hardship (OR 4.57, 95% CI 2.71-7.70, p=<0.0001). Among acute coronary syndrome survivors, 51% experienced household economic hardship, and those with the highest out-of-pocket expenditure had significantly greater odds of experiencing hardship (OR 4.57) compared to those with the lowest expenditure.
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