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Lipid Control and Medical Costs Among Patients With and Without Established Atherosclerotic Cardiovascular Disease
Pedro Gabriel Melo de Barros E Silva1,2, Henry Szneider1, Diego Ribeiro Garcia1
1United Health Group Brazil, São Paulo, Brazil.
Insights
Lipid control in Latin America is poor, with only 19.1% of Atherosclerotic Cardiovascular Disease (ASCVD) patients reaching LDL-C goals. Secondary prevention patients incur higher healthcare costs, primarily from hospitalizations, highlighting a gap in clinical practice.
Area of Science:
- Cardiology
- Public Health
- Health Economics
Background:
- Limited real-world data exists on lipid management and healthcare expenditures for patients with and without Atherosclerotic Cardiovascular Disease (ASCVD) in Latin America.
- Understanding these factors is crucial for improving cardiovascular disease prevention and management strategies in the region.
Purpose of the Study:
- To evaluate lipid control and associated healthcare costs in patients with and without ASCVD in Latin America.
- To identify disparities in lipid management and cost burdens between primary and secondary prevention populations.
Main Methods:
- A retrospective cohort study analyzed data from a health insurance database (2015-2017).
- Patients with and without ASCVD were identified using International Classification of Diseases (ICD) codes.
- Lipid control (LDL-cholesterol levels) and one-year healthcare costs were assessed for both groups.
Main Results:
- Of 17,434 patients, 5,208 (29.8%) had ASCVD. Only 19.1% of ASCVD patients achieved LDL-C < 70 mg/dL, and 4.1% achieved LDL-C < 50 mg/dL.
- Lipid control was significantly worse in women compared to men (13.1% vs. 25.7%).
- Average annual costs were $3,591 for primary prevention and $8,210 for secondary prevention patients, with hospital costs dominating the latter group.
Conclusions:
- Guideline-recommended lipid control targets are not adequately implemented in clinical practice in Latin America, despite evidence supporting intensive cholesterol reduction.
- Secondary prevention patients incur more than double the annual healthcare costs of primary prevention patients.
- Healthcare cost composition differs significantly, with hospital expenses being primary for secondary prevention and outpatient costs for primary prevention.
Background:
There is limited real-world data of lipid control and healthcare costs among patients with and without Atherosclerotic Cardiovascular Disease (ASCVD) in Latin America.
Methods:
A retrospective cohort study including patients with LDL-cholesterol (LDL-C) assessment from 2015 to 2017 was performed in a health insurance database. Patient characteristics, comorbidities and laboratory data were collected, and International Classification of Diseases (ICD) codes were used to identify a subcohort of patients with ASCVD (secondary prevention) and assess the proportion of these patients with LDL-C controlled. Lipid control among patients without ASCVD (primary prevention) and healthcare costs in one year in the overall population were also assessed.
Results:
From the 17,434 patients selected, 5,208 (29.8%) had ASCVD. The mean age of these patients in secondary prevention was 68.9 (±12.3) years and 47.8% were male patients. LDL-C < 70 mg/dL was identified in 19.1% of the ASCVD population and only 4.1% had an LDL-C < 50 mg/dL. LDL control was worse in women compared to men (13.1% vs. 25.7%; P < 0.01). The average cost in one year was 3,591 American dollars (USD) per patient in primary prevention compared to 8,210 dollars per year for patients in secondary prevention (P < 0.01). While outpatient costs accounted for 59.8% of the total cost in the primary prevention group, the main cost of the secondary prevention population was related to hospital costs (54.1%).
Conclusion:
Despite the favorable evidence for intensive cholesterol reduction, the evaluation of large real-world database with more than 17,000 individuals showed that the targets of guideline recommendations have not yet been adequately incorporated into clinical practice. Average annual cost per patient in secondary prevention is more than twice compared to primary prevention. Hospital expenses account for most of the cost in the secondary prevention group, while outpatient costs predominate in primary prevention.
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