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Variations in hospitalisation costs for acute myocardial infarction – a comparison across Europe


  • Oliver Tiemann


The aim of this study was to determine whether between‐country variations in hospital costs are larger than within‐country variations and, furthermore, to explore reasons for this variability. For this purpose, we chose the primary treatment of patients with acute myocardial infarction (AMI) as an episode of care. We obtained hospitalisation costs and reimbursement rates from 45 hospitals in nine different EU member states (i.e. Denmark, England, France, Germany, Hungary, Italy, Netherlands, Poland, and Spain) for the year 2005. To further analyse the variations in hospital costs, we employed a hierarchical random effects model based on treatment and hospital characteristics and using purchasing power parities (PPPs) as a proxy for country‐specific price levels. The between‐country standard error was estimated at €2473, whereas the within‐country standard error was estimated at €1242. Our regression analysis showed that percutaneous coronary intervention was associated with significantly increased hospitals costs compared to other treatment strategies. We were able to distinguish between three groups of countries with different cost levels based on the number of hospitals that were able to provide these services (i.e. percutaneous transluminal coronary angioplasty (PTCA) with intracoronary stenting). Excluding Hungary, Poland, and Spain, where none of the participating hospitals were able to provide these procedures, the between‐country standard error decreased to €1632, whereas the within‐country standard error increased to €1416. Finally, we observed exogenous price‐level effects between countries and within countries for hospitals located in urban areas. Copyright © 2008 John Wiley & Sons, Ltd.

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  • Oliver Tiemann, 2008. "Variations in hospitalisation costs for acute myocardial infarction – a comparison across Europe," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 33-45, January.
  • Handle: RePEc:wly:hlthec:v:17:y:2008:i:s1:p:s33-s45
    DOI: 10.1002/hec.1322

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    References listed on IDEAS

    1. David Epstein & Anne Mason, 2006. "Costs and prices for inpatient care in England: Mirror twins or distant cousins?," Health Care Management Science, Springer, vol. 9(3), pages 233-242, August.
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    4. Jonas Schreyögg & Tom Stargardt & Oliver Tiemann & Reinhard Busse, 2006. "Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries," Health Care Management Science, Springer, vol. 9(3), pages 215-223, August.
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    Cited by:

    1. Tamara Schmid, 2015. "Costs of treating cardiovascular events in Germany: a systematic literature review," Health Economics Review, Springer, vol. 5(1), pages 1-11, December.
    2. Cohen, Deborah & Manuel, Douglas G. & Tugwell, Peter & Sanmartin, Claudia & Ramsay, Tim, 2014. "Direct healthcare costs of acute myocardial infarction in Canada’s elderly across the continuum of care," The Journal of the Economics of Ageing, Elsevier, vol. 3(C), pages 44-49.
    3. Mads D. Faurby & Olaf C. Jensen & Lulu Hjarnoe & Despena Andrioti, 2017. "The costs of repatriating an ill seafarer: a micro-costing approach," Health Economics Review, Springer, vol. 7(1), pages 1-8, December.
    4. Jonas Schreyögg & Oliver Tiemann & Tom Stargardt & Reinhard Busse, 2008. "Cross‐country comparisons of costs: the use of episode‐specific transitive purchasing power parities with standardised cost categories," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 95-103, January.
    5. Reinhard Busse & Jonas Schreyögg & Peter C. Smith, 2008. "Variability in healthcare treatment costs amongst nine EU countries – results from the HealthBASKET project," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 1-8, January.
    6. Johannessen, Karl Arne & Kittelsen, Sverre A.C. & Hagen, Terje P., 2017. "Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis," Social Science & Medicine, Elsevier, vol. 175(C), pages 117-126.

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