Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 142 No. 3334 (2012)

Cost of acute coronary syndrome in Switzerland in 2008

  • Simon Wieser
  • Isabelle Rüthemann
  • Sylvia De Boni
  • Klaus Eichler
  • Mark Pletscher
  • Dragana Radovanovic
  • Tanja Ulle
  • Holger Auerbach
Cite this as:
Swiss Med Wkly. 2012;142:w13655


QUESTIONS UNDER STUDY: To perform a cost-of-illness study of acute coronary syndrome (ACS) in Switzerland from a societal perspective, evaluating direct costs, production losses and intangible costs in terms of quality adjusted life years (QALYs) lost.

METHODS: A bottom-up incidence-based approach was used. Data concerning patients with one or more ACS events were extracted from a national hospital database and from mortality statistics. Inpatient costs included acute care and rehabilitation. Outpatient costs included costs for ambulance, visits to GP and cardiologist, outpatient diagnostics, medication and rehabilitation. Production losses included absenteeism, permanent disability and premature death. Intangible costs were calculated on previously published QALY weights. Cost data were derived from official price lists, literature and experts. Future costs and QALYs lost were discounted.

RESULTS: In 2008 14,955 patients experienced a total of 16,815 ACS events; 2,752 died as a consequence of these. The resulting 19,064 hospital stays had an average across-hospital length of stay of 9.1 days per patient. Total direct costs of ACS amounted to 630 Mio Swiss Francs (CHF) for society and CHF 462 Mio for health insurers. Total direct costs were dominated by costs of myocardial infarction: ST-elevation 45.8%, non-ST-elevation 35.8%. Production losses were CHF 519 Mio and intangible costs resulted in 49,878 QALYs lost.

CONCLUSIONS: ACS causes considerable costs in terms of direct medical expenditures, lost production, suffering and premature death, even without taking into account costs for its chronic consequences such as congestive heart failure.


  1. Berger M, Bingefors K, Hedblom E, Pashos C, Torrance G, editors. Health care cost, quality and outcomes – ISPOR book of terms: International Society for Pharmacoeconomics and Outcome Research; 2003.
  2. Culyer AJ. The dictionary of health economics: Edward Elgar; 2005.
  3. Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. 3d ed: Oxford University Press; 2005.
  4. WHO. The top 10 causes of death. Geneva: World Health Organization; 2008.
  5. Sagmeister M, Horisberger B, Gessner U, Gutzwilller F, Wietlisbach V. The costs of ischaemic heart disease in Switzerland. Int J Health Sciences. 1990;1(1):5–16.
  6. Sagmeister M, Gessner U, Oggier W, Horisberger B, Gutzwilller F. An economic analysis of ischaemic heart disease in Switzerland. Eur Heart J. 1997;18(7):1102–9.
  7. Fox KAA, Steg PG, Eagle KA, Goodman SG, Anderson FA, Granger CB, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999–2006. J Am Med Assoc. 2007;297(17):1892–900.
  8. Krumholz HM, Wang Y, Chen J, Drye EE, Spertus JA, Ross JS, et al. Reduction in acute myocardial infarction mortality in the United States. J Am Med Assoc. 2009;302(7):767–73.
  9. Radovanovic D, Erne P. AMIS Plus: Swiss registry of acute coronary syndrome. Heart. 2010;96(12):917–21.
  10. Larg A, Moss JR. Cost-of-illness studies: A guide to critical evaluation. PharmacoEconomics. 2011;29(8):653–71.
  11. FSO. Medizinische Statistik der Krankenhäuser (detailed data obtained on special request). Neuchâtel: Federal Statistical Office; 2010.
  12. FSO. Todesursachenstatistik (detailed dataset obtained on special request). Neuchâtel: Federal Statistical Office; 2010.
  13. FSO. Lebensewartung nach Alter und Geschlecht (1998–2009). Neuchâtel: Federal Office of Statistics; 2010.
  14. FSO. Statistik diagnosebezogener Fallkosten: Fallkosten nach AP-DRG und Krankenhaustypologie – Jahr 2008. Neuchchâtel: Federal Statistical Office; 2010.
  15. FSO. Schweizerische Arbeitskräfteerhebung SAKE: Ständige Wohnbevölkerung, Erwerbsquote, Erwerbstätigenquote. Neuchâtel: Federal Statistical Office; 2010.
  16. FSO. Lohnstrukturerhebung. Neuchâtel: Federal Statistic Office; 2010.
  17. AMIS Plus. AMIS plus data 2008. University of Zurich; 2009.
  18. santésuisse. Tagestaxen in Heilanstalten – Konkordat der Schweizerischen Krankenversicherungen. 2008.
  19. Brüggenjürgen B, Rupprecht HJ, Willich SN, Spannagl M, Ehlken B, Smala A, et al. Cost of atherothrombotic diseases – myocardial infarction, ischaemic stroke and peripheral arterial occlusive disease in Germany. J Publ Health. 2005;13(4):216–24.
  20. Szucs TD, Berger K, März W, Schäfer JR. Kosteneffektivität von Pravastatin in der koronaren Sekundärprävention bei Patienten mit Myokardinfarkt oder instabiler Angina pectoris in Deutschland. Herz. 2000;25(5):487–94.
  21. Brønnum-Hansen H, Jørgensen T, Davidsen M, Madsen M, Osler M, Gerdes LU, et al. Survival and cause of death after myocardial infarction: the Danish MONICA study. J Clin Epidemiol. 2001;54(12):1244–50.
  22. Briffa T, Hickling S, Knuiman M, Hobbs M, Hung J, Sanfilippo FM, et al. Long term survival after evidence based treatment of acute myocardial infarction and revascularisation: follow-up of population based Perth MONICA cohort, 1984–2005. BMJ. 2009;338.
  23. Setoguchi S, Glynn RJ, Avorn J, Mittleman MA, Levin R, Winkelmayer WC. Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge: A 10-year trend analysis. J Am Coll Cardiol. 2008;51(13):1247–54.
  24. Vaccarino V, Berkman LF, Krumholz HM. Long-term outcome of myocardial infarction in women and men: a population perspective. Am J Epidemiol. 2000;152(10):965–73.
  25. Marchioli R, Avanzini F, Barzi F, Chieffo C, Di Castelnuovo A, Franzosi MG, et al. Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations; GISSI-prevenzione mortality risk chart. Eur Heart J. 2001;22(22):2085–103.
  26. FSO. Kodierungshandbuch – Der offizielle Leitfaden der Kodierregeln. Neuchâtel; 2009.
  27. FSO. Kosten und Finanzierung des Gesundheitswesens – Detaillierte Ergebnisse 2008 und jüngste Entwicklung. Neuchâtel: Federal Statistics Office; 2011.
  28. WHO collaborating centre for drug statistics methodology [Internet]. ATC/DDD Index 2011; [1.6.2011]. Available from:
  29. Tarmed-Suisse. Tarmed Tarifkatalog. Vol. 01.05.03; 2008.
  30. FOPH [Internet]. List of pharmaceutical specialties; January 2011. Available from:
  31. Bhattacharyya MR, Perkins-Porras L, Whitehead DL, Steptoe A. Psychological and clinical predictors of return to work after acute coronary syndrome. Eur Heart J. 2007;28(2):160–5.
  32. Hauptverband der österreichischen Sozialversicherungsträger. Statistisches Jahrbuch der österreichischen Sozialversicherungen. 2009.
  33. Aasa M, Henriksson M, Dellborg M, Grip L, Herlitz J, Levin LA, et al. Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction – results of the Swedish early decision reperfusion study (SWEDES) trial. Am Heart J. 2010;160(2):322–8.
  34. Ara R, Brazier JE. Populating an economic model with health state utility values: moving toward better practice. Value Health. 2010;13(5):509–18.
  35. SNB. Statistisches Monatsheft Mai 2011 – Preise und Löhne – Konsumentenpreise – Total (monatlich). Swiss National Bank; 2011.
  36. SNB. Schweizerische Nationalbank – Statistisches Monatsheft Mai 2011 – Zinssätze und Renditen. Swiss National Bank; 2011.
  37. Bramkamp M, Radovanovic D, Erne P, Szucs T. Determinants of costs and the length of stay in acute coronary syndromes: a real life analysis of more than 10,000 patients. Cardiovascular Drugs & Therapy. 2007;21(5):389–98.
  38. Taylor MJ, Scuffham PA, McCollam PL, Newby DE. Acute coronary syndromes in Europe: 1-year costs and outcomes. Current Medical Research & Opinion. 2007;23(3):495–503.
  39. Kanichay R, Wilsdon T, Connolly S, Sauri L. The economic and societal burden of acute coronary syndrome in Canada. Draft Final Methodology Report. London: Charles River Associates; 2010.
  40. OBSAN [Internet]. Schweizerisches Gesundheitsobservatorium OBSAN: Gesundheitszustand – Spezifische Diagnosen – Myokardinfarkt; [cited 2012 Jun 18]. Available from:

Most read articles by the same author(s)

1 2 > >>