Chronic stable angina (CSA) is a debilitating disease affecting about 1.9% (486,000) Canadians and heart disease accounts for about 16% of all visits to family physicians. They found that a self-management program significantly improved physical functioning, angina frequency, and ability to self-manage the disease, in the short-term but did not affect costs. Annual societal costs were estimated to be $19,209 per person, showing that CSA is a major economic burden on Canadian society. This study calls for further work to find cost-effective secondary preventive strategies for CSA as well as further research to determine long-term effects of the self-management training program trialed in this study, as results from other self-management programs have demonstrated cost reductions.

Background: Chronic stable angina (CSA) is a major clinical problem in Canada, negatively impacting quality of life, role functioning, activity level, and ability to self-manage. Heart disease affects about 5% of all Canadians, and 1.9% (486,000) live with angina. Furthermore, about 16% of all visits to family practitioners are related to heart disease. A self-management training program showed significant improvement in physical functioning, angina frequency, and ability to self-manage the disease, in the short-term. As part of this clinical trial, impact of the program on angina costs and societal costs of the disease was determined.

Methods: Costs were measured using the Ambulatory and Home Care record which collects comprehensive data on direct and indirect costs of illness from a societal perspective including cost to the public healthcare system, patient, caregiver, employer, and third party insurance. Direct costs included out of pocket costs to the patient for appointments, health professional and domestic care in the home, drugs and supplies or equipments related to heart disease. Indirect costs were estimated by valuing unpaid time spent in caregiving by family, friends, and patients themselves, including attending appointments and doing household chores. System costs included those covered under OHIP (fees to physicians), private insurers, homecare provided by the Toronto Community Care Access Centre, as well as supplies and drugs, including those covered by the Ontario Drug Benefit Program. Total annual costs were derived by annualizing two months of costs (one at baseline and one at three months). Despite its limitations, this method of annualizing costs was the most appropriate method for determining annual costs because no differences were found between baseline and three months.

Findings: Results indicated that of the 117 patients completing the study, the self-management program did not significantly impact CSA related costs at 3 months. Of total costs, indirect costs accounted for over onehalf, system costs for over one third, and direct costs comprised the smallest component. Estimated in 2004 Canadian dollars, total costs at baseline were $1,865 for the treatment group and $1,221 for the control group. Total estimated annual costs of CSA were $19,209 per person. Findings of no significant difference between the control and treatment groups were attributed to two major factors: (1) the short follow-up period, thereby leaving insufficient time for the self-management program to affect a reduction in indirect costs as patients were still trying to determine which strategies fit with their lifestyle, and (2) the inclusion of prescheduled appointments with cardiologists and primary care physician in system costs, which fell into the 4-week followup time period. However, they claim, in the longer-term, indirect and system costs have potential for reduction as demonstrated with other self-management programs.

Conclusions: This study revealed that CSA has a significant economic burden on society with an annual cost per person estimated at $19,209. This economic burden calls for a need to advance cost-effective secondary prevention strategies for chronic stable angina and for further research to determine the long-term cost-effectiveness of the self-management program in this study.

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