The Healthcare Cost Burden in Adults with High Risk for Cardiovascular Disease

Abstract

Objective: We calculated the short- and long-term care resource use and costs in adults with high-risk conditions for cardiovascular disease (HRCVD) as defined by the Canadian Cardiovascular Society dyslipidemia guidelines.

Methods: We linked Alberta health databases to identify patients aged ≥ 18 years with HRCVD between fiscal year (FY) 2012 and FY2016. The first HRCVD event was the index event. Patients were categorized into (1) primary prevention patients and (2) secondary prevention patients at the index event and were followed until death, they moved out of the province, or they were censored at March 2018. We calculated the resource use and costs for each of the 5 years after the index event.

Results: The study included 459,739 HRCVD patients (13,947 [3%] were secondary prevention patients). The secondary prevention patients were older (median age 61 years vs. 55 years; p < 0.001), and there were fewer females in this group (30.4% vs. 51.3%; p < 0.001). The total healthcare costs in the first year decreased over time (FY2012: 1.16 billion Canadian dollars (CA$); FY2016: CA$1.05 billion; p < 0.001). An HRCVD patient incurred CA$12,068, CA$5626, and CA$4655 during the first, second, and fifth year, respectively (p for trend < 0.001). During the first year, healthcare costs per secondary prevention patient (CA$36,641) were triple that for a primary prevention patient (CA$11,299; p < 0.001), primarily due to higher hospitalization costs in secondary prevention patients (CA$26,896 vs. CA$6051; p < 0.001).

Conclusions: The healthcare costs for HRCVD patients were substantial but decreased over time. The costs were highest in the year following the index event and decreased thereafter. Secondary prevention patients incurred higher costs than the primary prevention patients.

Fig. 1

Patient selection flowchart. *(1) A patient identified in the laboratory database was reallocated to the hospital cohort if the test was conducted during hospitalization. (2) A patient identified in the ambulatory care database was reallocated to the hospital cohort if that patient was hospitalized within 1 day. (3) A patient identified in the physician database was reallocated to the hospital cohort if the claim originated from a hospitalization. FY fiscal year, HRCVD high-risk conditions for cardiovascular disease, pt patient

Fig. 2

Incidence and number of patients with HRCVD in Alberta, 2012–2016. HRCVD high-risk conditions for cardiovascular disease

Fig. 3

First-year healthcare costs for patients with HRCVD in Alberta, in millions (2019 Canadian dollar values), 2012–2016. HRCVD high-risk conditions for cardiovascular disease

Fig. 4

Distribution of costs per patient by year from incidence in Alberta, 2012–2016