Costs of payment in Thai acute coronary syndrome patients.

BACKGROUND: Acute coronary syndrome (ACS) is a major health care syndrome that can financially burden patients throughout the world, including Thailand. Few studies purposed estimating the costs of treatment. The data from the ACS registry database represented the costs of hospital charges paid by ACS patients. Although these were not the actual treatment costs, the authors can approximately estimate the total expenditure for the first admission. OBJECTIVES: First, calculate the cost of ACS to the patients, including diagnostic, demographic data, treatment modalities, type of payers, hospital profile, and outcomes. Second, find the appropriate model to identify the independent factors for predicting the treatment costs. MATERIAL AND METHOD: The present study collected data from the second and third phase of a national multicenter prospective registry of ACS in Thailand, Thai ACS registry (TACSR). 3,552 patients with new onset of ACS were analyzed. RESULTS: Median age was 67 years (range 26.5-105.5) with predominately male and median length of stay (LOS) was 7 days (range, 1-184). 42% referred from other hospitals. The median cost of the total population was 47,908 baht (range, 633-1,279,679). When classified into those of STEMI, NSTEMI, and UA, the costs were 82,848.5, 40,531 and 26,116 baht respectively, p < 0.0001. Patients in the government hospital had to pay the total cost with PCI and CABG, 152,081-161,374 baht and 203,139-223,747 baht respectively, while the private hospital charged almost twice as much. For the types of payers, private insurance including private employee security fund paid significantly more than others. Costs in patients paid by "30 baht na tional health scheme and social security fund" were significantly less than those of others. For modality of treatment in STEMI, primary PCI was significantly more costly than thrombolytics and no reperfusion therapy, 161,096.5 vs. 60,043.0 and 33,335.0 baht respectively p < 0.0001. Early invasive groups in NSTEMI/UA had much higher median costs 145,794.0 baht when compared to those of the conservative group, 47,908 baht, p < 0.0001. Two multiple linear regression models according to the diagnostic group identified the independent factors for predicting cost. PCI, LOS, CABG, admission in a private hospital, Death, GPIIb/IlIa inhibitors use, major bleeding, coronary angiogram, thrombolytics use, age and diabetes were independent predictors for the cost in STEMI patients, R2 = 0.58. For those of NSTEMI/UA, the independent predictors for the cost were PCI, LOS, CABG, admission in a private hospital, death, GP IIb/IIIa inhibitors use, major bleeding, coronary angiogram, age, ventricular arrhythmia, CHF and referred patients, R2 =0.62. CONCLUSION: Costs in ACS patients were markedly different among diagnostic groups. The clinical risk factors were hospital type, type of payers, referred system, treatment procedures, drugs used and complications including outcome. Some of these factors could independently predict the costs.

Predictors of in-hospital mortality in non-ST elevation acute coronary syndrome in Thai Acute Coronary Syndrome Registry (TACSR).

OBJECTIVE: To determine baseline prognostic factors of in-hospital mortality in Thai patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). MATERIAL AND METHOD: Among 5,537 NSTE-ACS patients enrolled in Thai Acute Coronary Syndrome Registry, a univariate analysis and multivariate analysis were used to estimate the relationship of baseline clinical variables and in-hospital mortality. Variables examined included demographics, history and presenting characteristics. RESULTS: The in-hospital mortality rate was 9.5%. The statistically significant, adjusted baseline prognostic factors of in-hospital death were older age > or =65 years) (odds ratio [OR] 2.2, 95% confidence interval [CI] = 1.54-3.09), shock at presentation (OR 4.6, 95%CI = 2.91-7.32), heart failure (OR 3.1, 95%CI = 2.15-4.38), positive cardiac marker (OR 1.7, 95%CI = 1.18-2.53), arrhythmia (OR 12.3, 95%CI = 8.71-17.35), major bleeding (OR 2.9, 95%CI = 1.84-4.51), and cerebrovascular accident (OR 4.9, 95% CI = 2.42-9.97). While dyslipidemia (OR 0.6, 95%CI = 0.45-0.87), having percutaneous coronary intervention (OR 0.6, 95% CI = 0.39-0.94), receiving aspirin (OR 0.6, 95%CI = 0.33-0.94), beta-blocker (OR 0.5, 95% CI = 0.40-0.73), angiotensin converting enzyme inhibitor (OR 0.6, 95% CI = 0.43-0.78) and nitrate (OR 0.5, 95%CI= 0.35-0.76) were associated with lower in-hospital mortality. CONCLUSION: The in-hospital mortality is higher in Thai NSTE-ACS patients compared to other populations. The present study supports and confirms the prognostics importance of several baseline characteristics reported in previous studies.

Plasma homocysteine and ischemic stroke patients in Thailand.

BACKGROUND: Hyperhomocysteinemia was recently found to be a risk factor for stroke; however, the available data from Thailand is scarce. OBJECTIVE: To study plasma homocysteine levels in ischemic stroke and compare it with age-and sex-matched controls, and to identify the association of plasma homocysteine and subtype of stroke. MATERIAL AND METHOD: The authors studied plasma homocysteine levels of ischemic stroke patients with clinical signs and symptoms of stroke as confirmed by CT scan and compared them with control subjects who presented with other diseases and no clinical signs and symptoms of stroke between June 2000- May 2001 in Prasat Neurological institute. Fasting plasma homocysteine was measured by HPLC technique. Abnormal cut off point of plasma homocysteine was identified and associations of plasma homocysteine and stroke were studied by using logistic regression analyses. RESULTS: Two hundred and sixty-eight patients were recruited in the present study (132 controls and 136 ischemic stroke patients). The abnormal cut off point of plasma homocysteine was > 14 micromol/L. The authors found statically significant association of abnormal plasma homocysteine and stroke (p<0.001) with odds ratio of 4.277 (95%CI 2.551-7.171). After adjusting the confounding factor the authors found that high homocysteine was significantly associated with ischemic stroke (p<0.001) with odd ratio of 3.401 (95%CI 1.954-5.922). In the subgroup analyses of type of stroke and abnormal homocysteine, the authors demonstrated that abnormal homocysteine levels were more pronounced in the large vessel subtype than the small group. CONCLUSION: Abnormal homocysteine level is an independent risk factor of ischemic stroke and more correlated with large vessel subtype.

Association between serum homocysteine, folate and B12 concentration with coronary artery disease in Thai patients.

BACKGROUND: Hyperhomocysteinemia, associated with low folate and low B12 levels, is known to be an independent risk factor for atherosclerosis. Only a few available data has been demonstrated in Thai patients. OBJECTIVE: To evaluate serum fasting homocysteine, folate and B12 levels whether to see they are associated with coronary artery disease (CAD). METHOD AND RESULT: Three hundred and one consecutive suspected CAD patients who underwent coronary angiography at the Police General Hospital were studied. The mean age of the patients, 195 males and 106 females, was 63.0 +/- 10.0 year (range 39-85). A total of 218 patients were angiographically demonstrated as having CAD. The mean serum homocysteine level of CAD patients had a non significant higher level than those of 83 non CAD patients: 11.4 +/- 6.2 vs 10.2 +/- 4.2 umol/L, p = 0.06. Means of folate and B12 level in the CAD patients and non CAD patients were 6.6 +/- 4.6 vs 7.0 +/- 4.3 nmol/L, p = 0.49 and 650.9 +/- 415.4 vs 613.3 +/- 443.2 pmol/L, p = 0.56 respectively. No significant correlations were found between homocysteine with folate and B12 levels. Logistic regression analysis showed a significant association between homocysteine and CAD with OR = 1.08 (95%CI, 1.01-1.16), p = 0.03 after being adjusted for age, sex, DM, HT history of hyperlipidemia, smoking, BMI, folate and B12 levels. No significant association between homocysteine level with the number of coronary vessel stenosis, age, BMI, DM, HT smoking and history of hyperlipidemia was observed in the present study. CONCLUSION: Hyperhomocyteinemia, but not folate and B12 levels, may be an independent risk factor for coronary artery disease in Thai patients.