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Methods for estimating costs in patients with hyperlipidemia experiencing their first cardiovascular event in the
Mark D Danese1, Michelle Gleeson1, Robert I Griffiths1,2
1a Outcomes Insights, Inc. , Westlake Village , CA , USA.
Insights
Hospitalizations are the primary cost driver for cardiovascular event patients in the UK. Detailed costing of healthcare utilization is feasible but labor-intensive, highlighting the need for standardized drug data.
Area of Science:
- Health Economics
- Cardiovascular Medicine
- Health Services Research
Background:
- Integrating external costs into clinical databases is challenging.
- Hyperlipidemia patients experiencing cardiovascular (CV) events incur significant healthcare costs.
- Understanding these costs is crucial for resource allocation and management in the UK.
Purpose of the Study:
- To describe and implement methods for estimating the costs associated with managing hyperlipidemia patients with CV events in the UK.
- To quantify the costs of hospitalizations, prescriptions, and healthcare visits for this patient population.
- To provide a framework for incorporating external cost data into clinical databases.
Main Methods:
- Retrospective cohort study using UK Clinical Practice Research Datalink and Hospital Episode Statistics.
- Inclusion of patients (≥18 years) with first CV-related hospitalization and ≥2 lipid-lowering therapies (2006-2012).
- Costing based on NHS reference costs and PSSRU labor costs for acute (6-month) and long-term (30-month) periods.
Main Results:
- Cohort comprised 24,093 patients with CV hospitalizations.
- Analysis included 69,240 hospitalizations, 673,069 GP visits, 32,942 specialist visits, and 2,572,792 prescriptions.
- Mean costs (£2014) were highest for hospitalizations (£4,060 acute, £1,433 long-term), followed by medications and GP visits.
Conclusions:
- Hospitalizations represent the largest component of both acute and long-term costs for hyperlipidemia patients with CV events.
- Detailed costing using utilization data is feasible and reflects UK clinical practice, though it is labor-intensive.
- Standardization of UK drug costing data is recommended to improve efficiency.
Aims:
Methods for integrating external costs into clinical databases are not well-characterized. The purpose of this research was to describe and implement methods for estimating the cost of hospitalizations, prescriptions, and general practitioner and specialist visits used to manage hyperlipidemia patients experiencing cardiovascular (CV) events in the United Kingdom (UK).
Methods:
This study was a retrospective cohort study using the Clinical Practice Research Datalink and Hospital Episode Statistics data. Costs were incorporated based on reference costs from the National Health Service, and labor costs from the Personal Social Services Research Unit. The study population included patients seen by general practitioners in the UK from 2006-2012. Patients ≥18 years were selected at the time of their first CV-related hospitalization defined as myocardial infarction, ischemic stroke, heart failure, transient ischemic attack, unstable angina, or revascularization. To be included, patients must have received ≥2 lipid-lowering therapies. Outcome measures included healthcare utilization and direct medical costs for hospitalizations, medications, general practitioner visits, and specialist visits during the 6-month acute period, starting with the CV hospitalization, and during the subsequent 30-month long-term period.
Results:
There were 24,093 patients with a CV hospitalization included in the cohort. This study identified and costed 69,240 hospitalizations, 673,069 GP visits, 32,942 specialist visits, and 2,572,792 prescriptions, representing 855 unique drug and dose combinations. The mean acute period and mean annualized long-term period costs (2014£) were £4,060 and £1,433 for hospitalizations, £377 and £518 for GP visits, £59 and £103 for specialist visits, and £98 and £209 for medications.
Conclusions:
Hospital costs represent the largest portion of acute and long-term costs in this population. Detailed costing using utilization data is feasible and representative of UK clinical practice, but is labor intensive. The availability of a standardized coding system in the UK drug costing data would greatly facilitate drug costing.
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