Costs of Payment in Thai Acute Coronary Syndrome Patients
Worachat Moleerergpoom MD*, Rungsrit Kanjanavanit MD**, Woravut Jintapakorn MD***, Piyamitr Sritara MD****
Affiliation : * Cardiology Unit, Department of Medicine, Police General Hospital, Bangkok ** Division of Cardiology, Department of Medicine, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai *** Division of Cardiology, Department of Medicine, Songklanagarind Hospital, Songkhla **** Division of Cardiology, Department of Medicine, Ramathibodi Hospital, Bangkok
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 expendi-
ture 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.
Materials and Methods : The present study collected data from the second and third phase of a national multi-
center 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, GP IIb/IIIa 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.
Keywords : Costs of payment, Acute coronary syndrome, Thai ACS registry
