Healthcare Resource Utilization and Costs by Cardiovascular Risk Level: Results From the Latino Study

OBJECTIVES: This analysis aimed to assess healthcare resource utilization (HRU) and respective costs by cardiovascular (CV) risk level in patients followed at a Portuguese local health unit.

METHODS: Multicenter cohort study (LATINO) using data from 14 primary care centers and a central hospital in the north of Portugal. Patients aged 40-80 years-old, alive at 31/12/2019 (index date), and with ≥1 general practitioner (GP) appointment in the 3 years prior to index date were included. Data sources were all electronic health records since health unit inception (2000-2019). HRU included lifetime hospital episodes (hospitalizations, outpatient visits, and emergency room [ER] visits) and GP appointments. Lifetime (2000-2019) costs were calculated based on the reference cost for each episode (excluding therapy and test and diagnostic procedures costs). CV risk categories were defined according to 2019 ESC/EAS Guidelines.

RESULTS: A total of 81,731 patients (31% low, 28% intermediate, 21% high and 16% very high CV risk) and 5M lifetime episodes (24%, 27%, 24% and 25% in each CV risk category, respectively) were analyzed. Very high-risk patients were responsible for 42% of the lifetime hospitalizations, 46% of ER visits, 30% of outpatient and 24% of GP visits. Very high-risk patients’ hospitalizations corresponded to 52% of all hospitalization days (median length-of-stay of 4 days (IQR=[2, 8] days)). High-risk patients had 22%, 17%, 20% and 24% of the lifetime hospitalizations, ER, outpatient and GP visits, respectively. Despite being 37% of the total population, very high and high-risk patients represent 65% of total costs. The lifetime cost was 4,281€ per very high-risk patient and 1,699€ per high-risk.

CONCLUSIONS: There is a steep healthcare resource utilization in the highest CV risk patients. This data may help inform the development of impact assessment strategies to optimize disease management in the highest CV risk patients, reducing HRU and respective economic burden.