Burden of illness among patients at high risk versus low risk for major cardiovascular events

• Published in: Journal of medical economics Vol. 13; no. 3; p. 438
• Main Authors: Harley, Carolyn, Sander, Stephen D, Zarotsky, Victoria, Cao, Feng, Shah, Hemal
• Format: Journal Article
• Language: English
• Published: England 01.09.2010
• Subjects: Adolescent; Adult; Aged; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - economics; Cardiovascular Diseases - therapy; Cost of Illness; Female; Health Services - economics; Health Services - utilization; Humans; Insurance Claim Review; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Assessment; United States; Young Adult; United States
• ISSN: 1941-837X
• DOI: 10.3111/13696998.2010.496341

This study was designed to compare the burden of illness (BOI) in patients at high risk versus low risk of developing a major cardiovascular (CV) event. This retrospective claims data analysis included commercial health plan members identified with a primary diagnosis on a medical claim for cardiovascular disease (CVD) from January 1, 2001 through December 31, 2002. Patients were categorized as: low risk (LR), high risk (HR), or high risk aged≥55 (HR55), based on the ONTARGET clinical trial. Most patients (85%) were in the LR category (8% in HR55, 7% in HR). A significantly greater proportion of patients in the HR55 group were hospitalized and experienced a greater number of ambulatory visits compared with LR and HR patients. Controlling for covariates, HR55 patients averaged $22,502 in paid healthcare services over 2 years versus $15,645 for HR patients and $11,423 for LR patients (p<0.001). CV-related costs represented about 46% of costs for the HR55 group, versus 41% for the HR group and 31% for the LR group. Claims data are collected for the purpose of payment and not research and the presence of a diagnosis code is not proof of disease, due to possible coding errors or the use of a rule-out criterion. Also, patients who died in the follow-up were not included in the analyses, resulting in lower BOI estimates. Finally, the results of this study reflect treatment of CVD in managed-care settings, and may not be applicable to a different type of population. This study demonstrates the high BOI associated with CVD, especially for patients within the high-risk group aged≥55 years. Opportunities exist for reducing costs in this population.