A systematic review of the economic burden of chronic angina.

BACKGROUND: Chronic angina carries an economic burden because of symptom management, the risk of major cardiovascular events, and lost productivity. The level of these costs has not been systematically quantified.
OBJECTIVE: This study sought to assemble best evidence on the economic burden of chronic angina, including both the direct costs of healthcare and the indirect costs of lost productivity.
METHODS: Studies published in English from January 1990 to June 2003 were located via electronic and manual searches and systematically reviewed. Eligible studies included those with information on cost of illness, cost of treatment, employment status, and/or work productivity and/or limitations for a population of patients with chronic angina.
RESULTS: Seventeen studies assessed the healthcare cost of managing chronic angina. Cost estimates varied widely because of differing patient populations, healthcare settings, countries of origin, and year(s) of data collection. The most critical determinant of healthcare costs appeared to be the use of revascularization procedures. Twenty studies reported work limitations, 5 of which quantified productivity loss in monetary terms. Interventions for chronic angina resulted in some improvement in employment and work limitations over the short term. However, the positive effect of revascularization procedures tended to erode over the long term (3 years and beyond) in a substantial number of patients.
CONCLUSIONS: Chronic angina carries substantial healthcare costs caused by frequent medical visits, medications, and expensive revascularization procedures. Workplace productivity loss because of angina is also substantial, but lasting long-term improvement in work status has been difficult to achieve.