The Trade-Off between Costs and Outcomes: The Case of Acute Myocardial Infarction

Health Service Research, Vol. 45, No. 6, pp. 1585-1601, 2010

17 Pages Posted: 22 Feb 2011

See all articles by Jonas Schreyoegg

Jonas Schreyoegg

University of Hamburg - Faculty of Economics and Business Administration

Tom Stargardt

University of Hamburg

Date Written: December 2010

Abstract

Objective. To investigate and to quantify the relationship between hospital costs and health outcomes for patients with acute myocardial infarction (AMI) in Veterans Health Administration (VHA) hospitals using individual-level data for costs and outcomes.

Data Sources. VHA administrative files for the fiscal years 2000–2006.

Study Design. Costs were defined as costs incurred during the index hospitalization for treatment of AMI. Mortality and readmission, assessed 1 year after the index hospitalization, were used as measures of clinical outcome. We examined health outcomes as a function of costs and other patient-level and hospital-level characteristics using a two-stage Cox proportional hazard model that accounted for competing risks within a multilevel framework. To control for patient comorbidities, we compiled a comprehensive list of comorbidities that have been found in other studies to affect mortality and readmissions.

Principal Findings. We found that costs were negatively associated with mortality and readmissions. Every U.S.$100 less spent is associated with a 0.63 percent increase in the hazard of dying and a 1.24 percent increase in the hazard to be readmitted conditional on not dying. This main finding remained unchanged after a number of sensitivity checks.

Conclusions. Our results suggest that there is a trade-off between costs and outcomes. The negative association between costs and mortality suggests that outcomes should be monitored closely when introducing cost-containment programs. Additional studies are needed to examine the cost–outcome relationship for conditions other than AMI to see whether our results are consistent.

Keywords: Hospital costs, acute myocardial infarction, trade-off, outcomes, readmission, mortality

Suggested Citation

Schreyoegg, Jonas and Stargardt, Tom, The Trade-Off between Costs and Outcomes: The Case of Acute Myocardial Infarction (December 2010). Health Service Research, Vol. 45, No. 6, pp. 1585-1601, 2010. Available at SSRN: https://ssrn.com/abstract=1763786

Jonas Schreyoegg (Contact Author)

University of Hamburg - Faculty of Economics and Business Administration ( email )

Von-Melle-Park 5
Hamburg, 20146
Germany

Tom Stargardt

University of Hamburg ( email )

Hamburg Center for Health Economics
Esplanade 36
Hamburg, 20354
Germany

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