One-year costs associated with cardiovascular disease in Canada: Insights from the REduction of Atherothrombosis for Continued Health (REACH) registry

Abstract

Background and objectives: To provide a contemporary estimate of the economic burden of atherothrombosis in Canada, annual cardiovascular-related hospitalizations, medication use and associated costs across the entire spectrum of atherothrombotic disease were examined.

Methods: The REduction of Atherothrombosis for Continued Health (REACH) registry enrolled 1964 Canadian outpatients with coronary artery disease, cerebrovascular disease or peripheral arterial disease (PAD), or three or more cardiovascular risk factors. Baseline data on cardiovascular risk factors and associated medication use, and one-year follow-up data on cardiovascular events, hospitalizations, procedures and medication use were collected. Annual hospitalization and medication costs (Canadian dollars) were derived and compared among patients according to the presence of established atherothrombotic disease at baseline, specific arterial beds affected and the number of affected arterial beds.

Results: Average annualized medication costs were $1,683, $1,523 and $1,776 for patients with zero, one, and two or three symptomatic arterial beds, respectively. Average annual hospitalization costs increased significantly with the number of beds affected ($380, $1,403 and $3,465, respectively; P<0.0001 for overall linear trend). Mean hospitalization costs for patients with any coronary artery disease, any cerebrovascular disease and any PAD were $1,743, $1,823 and $4,677, respectively. After adjusting for other clinical factors, PAD at baseline was independently associated with a significant increase in hospitalization costs.

Conclusion: Costs associated with vascular-related hospitalizations and interventions for Canadian patients increased with the number of affected arterial beds, and were particularly high for patients with PAD and⁄or polyvascular disease. These contemporary data provide insight into the economic burden associated with atherothrombotic disease in Canada, and highlight the need for increased preventive strategies to lessen the burden for patients and society.

Figure 1)

REduction of Atherothrombosis for Continued Health (REACH) registry: Canadian risk profile (n=1976). CAD Coronary artery disease; CVD Cerebrovascular disease; PAD Peripheral arterial disease

Figure 2)

Average annual medication costs according to medication class. CAD Coronary artery disease; CVD Cerebrovascular disease; NSAIDS Nonsteroidal anti-inflammatory drugs; PAD Peripheral arterial disease

Figure 3)

Average one-year costs (Canadian dollars) associated with hospitalizations for vascular reasons per patient stratified according to the number of arterial beds affected (A) and according to the presence or absence of disease in specific arterial beds (B). CABG Coronary artery bypass grafting; CAD Coronary artery disease; CHF Chronic heart failure; CV Cardiovascular; CVD Cerebrovascular disease; MI Myocardial infarction; MRF Multiple risk factors; PAD Peripheral arterial disease; PCI Percutaneous coronary intervention; TIA Transient ischemic attack

Figure 4)

Mean hospitalization costs per patient (with 95% CIs) adjusted for covariates according to the number of affected arterial beds. MRFs Multiple risk factors