Long-Term ACS Costs, Often Hidden and Out-of-Pocket, Outstrip Direct Costs

November 06, 2012

LOS ANGELES — A lot of things have hidden costs that may come as a surprise if no one looks past direct or up-front expenses--for example, an MI or other acute coronary syndrome (ACS) event in a member of the US workforce. Employer health plans account for expected short-term costs for emergency-department service, hospitalization, procedures, and medications. But the researchers behind a new analysis say that the indirect costs, especially those related to long-term disability claims, are far more expensive for both employers and employees and can be overlooked [1].

The findings should encourage employers to "provide effective population health programs" for their workers aimed at diminishing risks that lead to ACS events, as well as providers to coordinate with employers in ways to reduce ACS-related disability, getting workers back on the job sooner, according to the group.

In other words, better focus on ACS prevention in employer health plans is likely to pay off later to a far greater extent than most current data, which is usually on direct and short-term costs, would predict, said lead author Dr Robert L Page (University of Colorado School of Pharmacy, Aurora). "The key will be primary prevention," he told heartwire .

Page described his data as among the first to show the long-term financial impact of ACS on the pockets of employees. ACS, he said, is expensive for patients in ways that are not currently recouped through any health plan. He presented the study here today at the American Heart Association (AHA) 2012 Scientific Sessions.

"We don't think of ACS as an illness of younger adults," Page said, "but unfortunately it is." About 47% of patients with ACS in the US are younger than the eligibility age for Medicare, he noted, and so rely on a healthcare reimbursement system dominated by employer-sponsored coverage.

Page and his colleagues combined two data sets to define the total cost burden associated with ACS, for both direct and indirect costs, on employees and in some cases their dependents. Medical and pharmacy claims and claims for both short-term and long-term disability from 2007 to 2010 were assessed in:

The group identified a total of 37 340 employees of companies mostly in the service, transportation, and manufacturing industries who had claims involving ACS; 95% were younger than 65.

Direct costs of ACS, including out-of-pocket expenses shouldered by the patient, for the one year following initial diagnosis averaged $8170 per patient, including about $6000 for inpatient care, $1300 for outpatient care, and $625 for prescriptions.

Employees claimed a mean 60.2 days of short-term disability yet were compensated for only 35.7 days on average. Their lost wages averaged $2263 while the cost to their employer in worker productivity lost to short-term claims reached a mean of $7943.

Those numbers are small compared with losses related to long-term disability, Page observed. On average, employees with ACS claimed 398 disability days, were compensated for only 271, and lost $20 609 per claim; lost productivity cost their employer a mean of $52 473 per long-term claim.

The current data suggest that the cost burden of ACS far exceeds what is predicted from the primarily short-term numbers that companies now consider when determining employee health coverage and that enhanced focus on ACS prevention might yield greater-than-expected savings down the road, commented Dr Richard C Becker (Duke University Medical Center, Durham, NC) to heartwire as a spokesperson for the AHA.

It's "not unreasonable" for employers to ask employees to participate in their own health in exchange for company-sponsored health coverage, he said.

That could go a long way toward addressing some current concerns about employer health plans. "We have a decreasing number of employers that are willing to take risks for someone to become ill. But at the same time, there are well-known risk factors for heart disease, including ACS, and as a result individuals can be actively involved in their health," Becker said.

The prospect of previously hidden savings over the long term for employees who avoid ACS should be incentive for employers to expand coverage of prevention efforts and other measures that help avert long-term disability. Although, Becker noted, there needs to be more study of the specific sources of long-term costs and what measures will help keep employees with long-term ACS-related claims on the job.

The study was funded by Janssen Pharmaceuticals. Page had no disclosures. Becker has previously reported being a consultant for AstraZeneca, Merck, Boehringer Ingelheim, and Daiichi Sankyo.