Variations in hospitalisation costs for acute myocardial infarction - a comparison across Europe

The aim of this study was to determine whether between‐country variations in hospital costs are larger than within‐country variations and, furthermore, to explore reasons for this variability. For this purpose, we chose the primary treatment of patients with acute myocardial infarction (AMI) as an e...

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Bibliographic Details
Published in:Health economics Vol. 17; no. S1; pp. S33 - S45
Main Author: Tiemann, Oliver
Format: Journal Article
Language:English
Published: Chichester, UK John Wiley & Sons, Ltd 01.01.2008
Wiley Periodicals Inc
Series:Health Economics
Subjects:
Analysis of Variance
Angioplasty
Angioplasty, Balloon, Coronary - economics
Angioplasty, Balloon, Coronary - utilization
Cardiac surgery
Comparative analysis
Costs
costs and cost analysis
Cross-Cultural Comparison
Diagnosis related groups
Economic models
Europe
European Union
European Union - economics
Health care expenditures
Health economics
Heart attacks
Hospital Costs
Hospitalization
Hospitals
Humans
Insurance, Health, Reimbursement - economics
International comparisons
Male
Medical treatment
Middle Aged
Myocardial infarction
Myocardial Infarction - economics
Myocardial Infarction - therapy
Patients
Price levels
Prices
Purchasing power
Purchasing power parity
Random effects
Regression Analysis
Stents
Stents - economics
Stents - utilization
Studies
Urban areas
Europe
ISSN:1057-9230, 1099-1050
Online Access:Get full text
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Summary:The aim of this study was to determine whether between‐country variations in hospital costs are larger than within‐country variations and, furthermore, to explore reasons for this variability. For this purpose, we chose the primary treatment of patients with acute myocardial infarction (AMI) as an episode of care. We obtained hospitalisation costs and reimbursement rates from 45 hospitals in nine different EU member states (i.e. Denmark, England, France, Germany, Hungary, Italy, Netherlands, Poland, and Spain) for the year 2005. To further analyse the variations in hospital costs, we employed a hierarchical random effects model based on treatment and hospital characteristics and using purchasing power parities (PPPs) as a proxy for country‐specific price levels. The between‐country standard error was estimated at €2473, whereas the within‐country standard error was estimated at €1242. Our regression analysis showed that percutaneous coronary intervention was associated with significantly increased hospitals costs compared to other treatment strategies. We were able to distinguish between three groups of countries with different cost levels based on the number of hospitals that were able to provide these services (i.e. percutaneous transluminal coronary angioplasty (PTCA) with intracoronary stenting). Excluding Hungary, Poland, and Spain, where none of the participating hospitals were able to provide these procedures, the between‐country standard error decreased to €1632, whereas the within‐country standard error increased to €1416. Finally, we observed exogenous price‐level effects between countries and within countries for hospitals located in urban areas. Copyright © 2008 John Wiley & Sons, Ltd.
Bibliography:European Commission within the Sixth Framework Research Programme - No. SP21-CT-2004-501588
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ArticleID:HEC1322
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ISSN:1057-9230
1099-1050
DOI:10.1002/hec.1322