Resource utilization and costs associated with achieved LDL-C levels in patients following a myocardial infarction treated with lipid-lowering therapies in Spain
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Session title: Public Health and Health Economics ePosters
Topic: Health Economics
Session type: ePosters
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Authors

C Escobar Cervantes1 , I Campos Tapias2 , F Sorio Vilela3 , J Lozano2 , DA Kahangire3 , A Sicras-Mainar4 , 1University Hospital La Paz, Cardiology - Madrid - Spain , 2Amgen S.A., Health Economics - Barcelona - Spain , 3Amgen (Europe) GmbH - Rotkreuz - Switzerland , 4Atrys-Health, HEOR - Barcelona - Spain ,

Abstract

Citation: N/A

Background/Introduction: Reduction in low-density lipoprotein cholesterol (LDL-C) significantly reduces cardiovascular (CV) risk, especially in patients with atherosclerotic CV disease. There is, however, a lack of evidence on the association between achieved LDL-C and resource utilization and costs.

Purpose: Assess the association of achieved LDL-C levels and resource use and costs in patients treated with lipid-lowering therapies (LLT) following a myocardial infarction (MI).

Methods: Retrospective observational study using the BIG-PAC® database, with anonymized electronic medical records from 1.9 million inhabitants from 7 regions in Spain.
Eligible patients were adults (≥18 years), hospitalized for an MI (index date) between January 2015 and December 2017, treated with LLTs (statins and/or ezetimibe) during follow-up (up to 18 months), and with recorded LDL-C values at baseline and follow-up. 
Direct (related to health care interventions) and indirect (related to loss of productivity) costs were estimated in 2018€. 
Costs incurred during follow-up were computed by achieved LDL-C. Achieved LDL-C was obtained in the year following the MI and at least 2 months after the index date. LDL-C categories were defined as per the 2016 and 2019 ESC/EAS guidelines for dyslipidaemias management: <55 mg/dL, 55-69 mg/dL, 70-99 mg/dL, 100-129 mg/dL and ≥130 mg/dL. Results were adjusted for age, gender, CV disease history and comorbidities.

Results: 6025 patients were included. Mean age (SD) was 69.7 (12.2) and 77% were male.
Resource use (not reported in this abstract) and costs monotonically increased with achieved LDL-C. Mean total costs ranged from 5044€ for patients with LDL-C <55 mg/dL to 7567€ for patients with LDL-C ≥130 mg/dL (Table 1).
Only 11% (641/6025) of patients reached recommended LDL-C levels for very-high-risk patients as per 2016 ESC/EAS guidelines (<70 mg/dL), and 1% (68/6025) the LDL-C levels (<55 mg/dL) proposed in the 2019 guidelines.

Conclusions: Achieving lower LDL-C levels following an MI may be associated to lower resource use and costs. Many patients do not achieve recommended LDL-C levels despite treatment with LLT. These data suggest that use of more intense LLT, with a greater reduction in LDL-C, would be beneficial from a clinical and economic perspective.

LDL-C categories <55 mg/dL 55-69 mg/dL 70-99 mg/dL 100-129 mg/dL ≥130 mg/dL
Number of patients (%) 68 (1.1) 573 (9.5) 2213 (36.7) 1995 (33.1) 1176 (19.5)

Direct cost €, mean

(95% CI)

2331

(1699-2963)

2401

(2188-2615)

2407

(2308-2506)

2619

(2520-2718)

2837

(2706-2968)

Indirect cost €, mean

(95% CI)

2714

(716-4711)

3645

(2970-4319)

3901

(3588-4214)

4412

(4100-4724)

4730

(4316-5144)

Total cost €, mean

(95% CI)

5044

(3048-7040)

6046

(5372-6720)

6308

(5995-6620)

7031

(6719-7343)

7567

(7153-7981)

CI: Confidence Interval