Healthcare resource utilization in patients on lipid-lowering therapies outside Western Europe and North America: findings of the cross-sectional observational International ChoLesterol management Practice Study (ICLPS)

Abstract

Background: Few recent large-scale studies have examined healthcare consumption associated with dyslipidemia in countries outside Western Europe and North America.

Methods: This analysis, from a cross-sectional observational study conducted in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America, evaluated avoidable healthcare consumption (defined as ≥1 hospitalization for cardiovascular reasons or ≥1 visit to the emergency room for any reason in the previous 12 months) in patients receiving stable lipid-lowering therapy (LLT). A total of 9049 patients (aged ≥18 years) receiving LLT for ≥3 months and who had had their low-density lipoprotein cholesterol (LDL-C) value measured on stable LLT in the previous 12 months were enrolled between August 2015 and August 2016. Patients who had received a proprotein convertase subtilisin/kexin type 9 inhibitor in the previous 6 months were excluded. Patients were stratified by cardiovascular risk level using the Systematic Coronary Risk Estimation chart for high-risk countries.

Results: The proportion of patients at their LDL-C goal was 32.1% for very-high risk patients compared with 55.7 and 51.9% for patients at moderate and high cardiovascular risk, respectively. Overall, 20.1% of patients had ≥1 reported hospitalization in the previous 12 months (7.9% for cardiovascular reasons), 35.2% had ≥1 intensive care unit stay and 13.8% visited the emergency room. Avoidable healthcare resource consumption was reported for 18.7% patients overall, and in 27.8, 7.7, 7.7 and 13.2% of patients at very-high, high, moderate and low risk, respectively. Across all risk groups 22.4% of patients not at LDL-C goal and 16.6% of patients at LDL-C goal had avoidable healthcare resource consumption. Being at very-high cardiovascular risk, having cardiovascular risk factors (including hypertension and smoking), and having factors indicating that the patient may be difficult to treat (including statin intolerance, comorbidities and chronic medication), were independent risk factors for avoidable healthcare resource consumption (all p <0.05).

Conclusions: Healthcare resource consumption associated with adverse clinical outcomes was observed in patients on stable LLT in countries outside Western Europe and North America, particularly those at very-high cardiovascular risk and those who were difficult to treat.

Keywords: Disease management; Dyslipidemia; Health resource; Observational study; Statins.

Fig. 1

Factors independently associated with avoidable healthcare consumption (mixed model of variables at patient level only; C-statistic: 0.7454 [0.7329; 0.7580]). CAD, coronary artery disease; CI, confidence interval; CVD, cardiovascular disease; DBP, diastolic blood pressure; OR, odds ratio; PAD, peripheral artery disease; SBP, systolic blood pressure

Fig. 2

Factors independently associated with avoidable consumption of healthcare resources (mixed model of variables at patient level and environmental variables; C-statistic: 0.7591 [0.7466; 0.7715]). CAD, coronary artery disease; CI, confidence interval; CVD, cardiovascular disease; DBP, diastolic blood pressure; OR, odds ratio; PAD, peripheral artery disease; SBP, systolic blood pressure