Avoided Costs Attributable to the Effectiveness of Optimal Management of Lipid-Lowering Agents in a Cohort of Patients at Cardiovascular Risk in the Colombian Caribbean

OBJECTIVES: To estimate the effectiveness attributable to the optimal management of lipid-lowering therapies in reducing the risk of cardiovascular events and their avoided costs for a cohort of people with established Atherosclerotic Cardiovascular Disease (ASCVD) or with an equivalent risk level of cardiovascular risk in the Caribbean Colombian.

METHODS: Retrospective cohort study and direct costs of care of people enrolled in a cardiovascular risk program of an institution that mainly insures low-income population. Participants were classified according to the fulfillment of clinical goals into those with optimal and non-optimal treatment of lipid-lowering therapies. The follow-up period was 12 months. The risk reduction of cardiovascular events (CVDE) was estimated using a Cox proportional hazards model and using a zero-inflated Poisson model for the estimation of hospital costs for CVDE avoided attributable to optimal management.

RESULTS: 50,683 people who met the inclusion criteria were analyzed. More than half of the population were women (62.6%). Only 2,911 (5.74%) patients with optimal LDL-C management were identified. Optimal management implied a reduction in the risk of CVDE occurrence at 12 months (HR 0.50, 95% CI 0.25, 0.97; p-value = 0.039) in participants with history of cardiovascular disease compared to the rest of the participants. A person with optimal management had average annual costs of US4,006 (95% CI 2,744, 5,267), while annual non-optimal management was US4,712 (95% CI 3,785, 5,639). A reduction of 20.1% (cost ratio 0.798; 95%CI 0.796, 0.801) was estimated in the average costs of CVDE hospitalizations for people with optimal LDL-C management compared to those who did not have this management.

CONCLUSIONS: In real-world settings, optimal hypercholesterolemia management reduces risk and healthcare costs. Enhancing lipid-lowering treatments and monitoring LDL-C in high cardiovascular risk individuals is essential to maximize future health outcomes.