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Health care resource utilization and costs associated with nonfatal major adverse cardiovascular events
Jennifer S Korsnes1, Keith L Davis, Rinat Ariely
1RTI Health Solutions, 200 Park Offices Dr., Research Triangle Park, NC 27709. jkorsnes@rti.org.
Insights
Recurrent cardiovascular events are common and costly after acute coronary syndrome (ACS) hospitalization. Understanding these risks and costs is crucial for evaluating new preventive treatments.
Area of Science:
- Cardiology
- Health Economics
- Epidemiology
Background:
- Recurrent cardiovascular events pose a significant risk post-initial hospitalization.
- Assessing event rates, healthcare utilization, and costs is vital for treatment value evaluation.
Purpose of the Study:
- To quantify rates of major adverse cardiovascular events (MACE) and secondary coronary events (SCE) in patients hospitalized for acute coronary syndrome (ACS).
- To evaluate health care utilization and costs associated with a first MACE in this patient population.
Main Methods:
- Retrospective analysis of administrative data from US managed care and Medicare enrollees (2006-2011).
- Follow-up of 75,231 patients for 12 months post-ACS hospitalization to assess MACE and SCE rates.
- Multivariable analyses to identify risk factors for MACE and associated costs.
Main Results:
- 3.3% of patients experienced a MACE and 8.3% an SCE within 12 months.
- Median time to first MACE was 4.6 months; mean MACE-related cost was $19,642.
- Age and diabetes increased MACE odds; ST-elevation myocardial infarction reduced odds. Statin use and age lowered costs; early MACE increased costs.
Conclusions:
- MACEs and SCEs are frequent and expensive burdens in the year after ACS hospitalization.
- Findings can inform economic assessments of novel MACE/SCE prevention therapies.
Background:
Risk of recurrent cardiovascular events following an initial cardiovascular-related hospitalization remains high despite available interventions. Rates of cardiovascular events as well as associated health care resource utilization and costs are needed to assess the value of treatments.
Objective:
To quantify, in patients with previous hospitalization for acute coronary syndrome (ACS), rates of nonfatal major adverse cardiovascular events (MACE) and secondary coronary events (SCE), as well as health care utilization and costs associated with a first MACE.
Methods:
Administrative data from a large population of commercial managed care and managed Medicare enrollees in the United States were retrospectively analyzed. Patients with an ACS-related hospitalization from 2006 to 2011 were followed for 12 months to assess subsequent MACE and SCE rates. Patients were aged ≥ 18 years at initial ACS hospitalization (the index episode) and had ≥ 12 months of continuous health plan enrollment before and after the end of the index episode. Resource utilization and costs during a first MACE were assessed. Multivariable analyses were used to assess the associations between cardiovascular risk factors and the occurrence of a MACE, as well as the costs incurred during a first MACE.
Results:
Of 75,231 study patients identified, 3.3% had a MACE and 8.3% had an SCE during the 12-month follow-up. Median time to first MACE and SCE from end of the index episode was 4.6 and 3.7 months, respectively. Mean MACE-related cost incurred during the first MACE was $19,642. Logistic analyses showed that age and diabetes were associated with increased odds of a MACE, while index ACS episodes involving ST-elevation myocardial infarction were associated with reduced odds. Findings from generalized linear models indicated that statin use and age were associated with lower episode-related costs and that MACE occurrence within 3 months of ACS hospitalization was associated with increased episode-related costs.
Conclusions:
MACEs and SCEs represent a common and costly burden in the year following ACS hospitalization. Our findings may inform future economic assessments of new therapies aimed at prevention of MACEs and SCEs.
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