Total First-Year Costs of Acute Coronary Syndrome in a Managed Care Setting

cute coronary syndrome (ACS) describes a continuum of acute ischemic cardiac conditions. The broad definition includes unstable angina (UA), non–ST-segment elevation m y o c a rdial infarction (MI), and ST-segment elevation M I.1 A c c o rding to the National Hospital Discharge Surv e y, nearly 1 million first-listed discharges for ACS-related diagnoses occurred in 2000 in the United States.2 Thus, the burden and cost of illness of ACS are quite high on a national basis. Guidelines for drug use in secondary prevention of cardiac events also have been developed. The 2001 therapy guideline update from the American Heart Association/American College of Cardiology, recommends aggressive lipid and blood pressure management, along with antiplatelets, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors in appropriate patients.3 However, data from the usual clinical practice setting continue to show a gap between these recommendations and actual practice.4,5 Several studies have estimated the U.S. cost of illness for ACS by using national data sources such as Medicare. However, little data are available in the typically younger, commercially insured population.6-9 Russell et al. analyzed data from the early to mid-1990s and estimated the first-year direct medical cost o