Direct healthcare costs of acute myocardial infarction in Canada’s elderly across the continuum of care

A growing number of healthcare policy initiatives around the world have focused on the continuum of care amongst the elderly, calling for renewed investments in integrated care to promote healthy aging and to reduce health system costs. The study objective was to examine healthcare costs and cost drivers for myocardial infarction (AMI) among Canadian Seniors across the care continuum from 2004 to 2012 in Ontario, Canada. Cost estimates represented direct community and hospital-based costs including physician services, diagnostic-testing, pharmaceuticals and hospitalizations obtained from Canadian healthcare data sources. Separate costs were calculated for pre-state care, the hospital event, and poststate care over a 6 year care continuum. Socio-demographic and co-morbid cost drivers were studied using negative binomial regression in a cohort of 16,450 first-time AMI seniors.

The average cost per patient across a six-year care continuum was $28,169 in 2008 constant Canadian dollars. Almost three-quarters of these costs were derived from the event phase ($20,794), while pre-state and post-state costs made up 12% and 14%, respectively ($3400 and $3974). Pre-state costs per patient day were half of post-state costs ($3.11 versus $6.32 per day) when adjusted for survival. Socio-demographic characteristics including age, gender and patient’s urban/rural residence, and comorbid illnesses were key cost drivers across the phases of care. This study provides a person-centered health system perspective in the economic burden of AMI in Canada’s elderly and will inform health policy related to integrated care strategies for heart disease in seniors.