Cost saving potential in cardiovascular hospital costs due to reduction in air pollution

Objective: We describe a methodological framework to estimate potential cost savings in Belgium for a decrease in cardiovascular emergency admissions (ischemic heart disease (IHD), heart rhythm disturbances (HRD), and heart failure) due to a reduction in air pollution.

Methods: Hospital discharge data on emergency admissions from an academic hospital were used to identify cases, derive risk functions, and estimate hospital costs. Risk functions were derived with case-crossover analyses with weekly average PM10, PM2.5, and NO2 exposures. The risk functions were subsequently used in a micro-costing analysis approach. Annual hospital cost savings for Belgium were estimated for two scenarios on the decrease of air pollution: 1) 10% reduction in each of the pollutants and 2) reduction towards annual WHO guidelines.

Results: Emergency admissions for IHD and HRD were significantly associated with PM10, PM2.5, and NO2 exposures the week before admission. The estimated risk reduction for IHD admissions was 2.44% [95% confidence interval (CI): 0.33%-4.50%], 2.34% [95% CI: 0.62%-4.03%], and 3.93% [95% CI: 1.14%-6.65%] for a 10% reduction in PM10, PM2.5, and NO2 respectively. For Belgium, the associated annual cost savings were estimated at € 5.2 million, € 5.0 million, and € 8.4 million respectively. For HRD, admission risk could be reduced by 2.16% [95% CI: 0.14%-4.15%], 2.08% [95% CI: 0.42%-3.70%], and 3.46% [95% CI: 0.84%-6.01%] for a 10% reduction in PM10, PM2.5, and NO2 respectively. This corresponds with a potential annual hospital cost saving in Belgium of € 3.7 million, € 3.6 million, and € 5.9 million respectively. If WHO annual guidelines for PM10 and PM2.5 are met, more than triple these amounts would be saved.

Discussion: This study demonstrates that a model chain of case-crossover and micro-costing analyses can be applied in order to obtain estimates on the impact of air pollution on hospital costs.