Assessment of unmet clinical needs and healthcare resource use among statin-treated patients with or at risk of developing atherosclerotic cardiovascular disease.

Abstract

Aim: Atherosclerotic cardiovascular disease (ASCVD) imposes considerable clinical and economic burdens. ASCVD prevention seeks to control low-density lipoprotein cholesterol (LDL-C) using statins as first-line treatment. This retrospective US cohort study assessed unmet clinical needs and healthcare resource use among statin users in primary and secondary prevention.

Materials and methods: MarketScan administrative claims 2017-2021 were leveraged and linked to laboratory data to identify patients with hypercholesterolemia followed for 2 years. Numbers of statin-treated hypercholesterolemia patients in primary prevention, very high-risk or not very high-risk secondary prevention, and their LDL-C goal achievement, were estimated and inflated to national estimates, along with annualized healthcare resource utilization and costs. Cardiovascular events according to LDL-C goal attainment were also assessed.

Results: Almost 125,000 statin-treated patients did not meet LDL-C goals. Data inflated to US national estimates suggested approximately 72 million (M) patients have hypercholesterolemia: 43 M primary prevention (∼40% above goal), 9.8 M very high-risk secondary prevention (∼78% above goal), and 9.1 M not very high-risk secondary prevention (∼60% above goal) are treated with statins, and 9.5 M are untreated (∼84% above goal). Managing LDL-C to goal was associated with a 50% reduction in the proportion of patients with a cardiovascular event. Patients utilizing high-cost healthcare services and annualized healthcare costs increased from primary to secondary prevention, and from not very high- to very high-risk secondary prevention.

Limitations and conclusions: Prevention is an essential component of any effort to improve population health and ultimately reduce spending. While some prevention efforts are cost-saving, some strategies that improve health will increase total spending. Nonetheless, millions of people in the US taking statins do not achieve LDL-C goals, indicating a significant clinical burden among those with, or at risk for, ASCVD, resulting in substantial healthcare resource use and costs.