Lipid Control and Medical Costs Among Patients With and Without Established Atherosclerotic Cardiovascular Disease Followed in a Brazilian Private Healthcare System.

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Global Heart Pub Date : 2024-08-14 eCollection Date: 2024-01-01 DOI:10.5334/gh.1345

Pedro Gabriel Melo de Barros E Silva, Henry Szneider, Diego Ribeiro Garcia, Valter Furlan, Renato Delascio Lopes

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Abstract

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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巴西私立医疗系统中已确诊和未确诊动脉粥样硬化性心血管疾病患者的血脂控制和医疗费用。

背景拉丁美洲动脉粥样硬化性心血管疾病（ASCVD）患者和非动脉粥样硬化性心血管疾病（ASCVD）患者血脂控制和医疗费用的真实世界数据有限：在医疗保险数据库中开展了一项回顾性队列研究，研究对象包括 2015 年至 2017 年接受低密度脂蛋白胆固醇（LDL-C）评估的患者。研究收集了患者特征、合并症和实验室数据，并使用国际疾病分类（ICD）代码确定了ASCVD（二级预防）患者亚群，并评估了这些患者中LDL-C得到控制的比例。此外，还评估了无 ASCVD（一级预防）患者的血脂控制情况和总体人群一年的医疗费用：在选取的 17,434 名患者中，5,208 人（29.8%）患有 ASCVD。这些二级预防患者的平均年龄为 68.9 (±12.3) 岁，47.8% 为男性患者。19.1%的 ASCVD 患者的低密度脂蛋白胆固醇（LDL-C）小于 70 毫克/分升，只有 4.1% 的患者的低密度脂蛋白胆固醇（LDL-C）小于 50 毫克/分升。与男性相比，女性的低密度脂蛋白控制较差（13.1% 对 25.7%；P < 0.01）。每位一级预防患者一年的平均费用为 3,591 美元，而二级预防患者一年的平均费用为 8,210 美元（P < 0.01）。一级预防组的门诊费用占总费用的59.8%，而二级预防组的主要费用与住院费用有关（54.1%）：尽管有证据表明强化降低胆固醇是有利的，但对拥有 17,000 多人的大型真实世界数据库进行的评估显示，指南建议的目标尚未充分纳入临床实践。二级预防中每位患者的年均成本是一级预防的两倍多。住院费用占二级预防组费用的大部分，而门诊费用在一级预防中占主导地位。

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.