Treatment Patterns and Healthcare-Related Costs in Patients with Atherosclerotic Cardiovascular Disease: Insights from a Large US Healthcare Insurer.

Abstract

Background and objective: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death in the USA. We evaluated lipid-lowering therapy (LLT) and the impact of adherence on healthcare costs among patients with ASCVD.

Methods: This observational cohort study used payor claims and outpatient laboratory data. Adults with ASCVD diagnosed from 1 October 2015 to 31 December 2019 were observed 12 months before, and up to 24 months after, first LLT use (index; categorized as any LLT, statin monotherapy, ezetimibe monotherapy, or anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibody [PCSK9 mAb] monotherapy). Treatment patterns, low-density lipoprotein cholesterol (LDL-C) measurements, LLT adherence (proportion of days covered ≥ 0.80), and healthcare resource utilization and costs were reported.

Results: Of patients with 12 months' follow-up post-ASCVD diagnosis, 35% did not receive LLT within 12 months. Among those receiving any LLT, 95.4% received statin monotherapy at index, 1.6% ezetimibe monotherapy, and 0.3% anti-PCSK9 mAb monotherapy. In the cohort with 12 months' follow-up post-index (N = 417,625), the proportion of adherent patients was 66.0% for statin monotherapy, 58.0% for ezetimibe, and 54.9% for anti-PCSK9 mAb users. Among adherent patients, 25.0% of statin, 13.5% of ezetimibe, and 37.7% of anti-PCSK9 mAb users achieved LDL-C < 70 mg/dL within 12 months. ASCVD-related 12-month per patient per month medical costs were higher for nonadherent patients across LLT categories except ezetimibe.

Conclusions: The high proportion of patients not reaching their LDL-C goal, including those adherent to LLT, demonstrates persistent gaps in care. Adherent patients had lower LDL-C and lower ASCVD-related costs.