OBJECTIVE: This study determined the economic burden for nonfatal uncomplicated acute coronary syndrome (ACS) using 100% compliance to certain a) non-invasive or b) invasive and non-invasive diagnostic and therapeutic interventions with class I recommendations in the American College of Cardiology-American Heart Association (ACC-AHA) clinical practice guidelines for ACS in three tertiary hospitals using the societal perspective. It also determined the costs using the patient perspective in the setting of one private tertiary hospital.

METHODS: This study was a cost analysis that included a) costs of patient resources, b) production losses, and c) costs of other resources or sectors, from hospitalization to one month post-discharge for ACS. Several models were constructed due to variations in the costs of diagnostic and therapeutic interventions in the three settings.

RESULTS: Using the societal perspective, one model for non-invasive options yielded the following (costs as of January 31, 2009): hospital A, Php87,014 - 124,799; hospital B, Php75,592 - 96,072; hospital C, Php71,969 - 92,148. Excluding fibrinolytic therapy, the lowest total cost would be Php65,000. However, if coronary angiography was added to the models for hospital C, the cost was Php107,154 - 134,574 (coronary angiography was not available in hospitals A and B). Using the patient perspective, the adjusted mean cost for the model which used the least expensive medication was Php96,421 (Standard Deviation = 34,076).

CONCLUSION: The economic burden for nonfatal uncomplicated ACS may range from Php65,000 - 134,574.

United States ; American Heart Association ; Acute Coronary Syndrome ; Coronary Angiography ; Tertiary Care Centers ; Hospitalization ; Patient Discharge ; Thrombolytic Therapy

BACKGROUND: The pattern of the contrast media-induced adverse reactions has not been investigated extensively in Mexico. OBJECTIVE: To estimate the incidence and the degree of severity of the adverse reactions to contrast media, administered for the first time, in hospitalized subjects. METHODS: We studied 99 patients longitudinally on whom computed tomography with contrast media (iopamidol) was carried out. The adverse reactions were identified by clinical examination; subsequently, they were classified as mild, moderate and severe, following the Manual on Contrast Media version 9 guides, and as immediate and nonimmediate. In addition, the vital functions, oxygen saturation, serum creatinine levels and the total number of eosinophils were measured before and after the procedure. RESULTS: The incidence of immediate and nonimmediate adverse reactions was of 26.3% and 10.1%, respectively. The mild immediate reactions were 18 (69.2%), the most common being the sensation of warmth, nausea and pruritus; among the more delayed reactions, nephrotoxicity stood out (5.1%). The serum creatinine median showed no difference either before or after the intravenous injection of contrast media (p = 0.13); in contrast, there was a significant difference in the total number of eosinophils (p ≤ 0.001). The values of high baseline systolic blood pressure and the diminished baseline amounts in pulse oximetry were significantly related with any type of the adverse reactions to contrast media. CONCLUSION: The incidence of the adverse reactions to contrast media was greater with respect to previous reports; the majority of these reactions were of the immediate type and of a mild nature. The risk factors that have mostly been implicated in the adverse reactions to contrast media could not be identified in our cohort.
Blood Pressure ; Cohort Studies ; Contrast Media ; Creatinine ; Drug-Related Side Effects and Adverse Reactions ; Eosinophils ; Humans ; Incidence ; Injections, Intravenous ; Mexico ; Nausea ; Oximetry ; Oxygen ; Pruritus ; Risk Factors ; Sensation ; Tomography, X-Ray Computed