Assessing Differences in Clinical Burden Across Payers for Non-Obstructive Hypertrophic Cardiomyopathy
Author(s)
Nosheen Reza, MD, FACC, FHFSA1, Mike Butzner, Jr., DrPH, MPH2, Kirti Batra, BSc3, Qiana Amos, PhD, MPH3, Ami Buikema, MPH3, Paulos Gebrehiwet, PhD2, Sanatan Shreay, PhD, MS2, Anjali T Owens, MD1;
1Hospital of the University of Pennsylvania & the Perelman School of Medicine at the University of Pennsylvania, Division of Cardiovascular Medicine, Philadelphia, PA, USA, 2Cytokinetics, Inc., HEOR, South San Francisco, CA, USA, 3Optum LifeSciences, HEOR, Eden Prarie, MN, USA
1Hospital of the University of Pennsylvania & the Perelman School of Medicine at the University of Pennsylvania, Division of Cardiovascular Medicine, Philadelphia, PA, USA, 2Cytokinetics, Inc., HEOR, South San Francisco, CA, USA, 3Optum LifeSciences, HEOR, Eden Prarie, MN, USA
OBJECTIVES: There is no evidence on the association of payer coverage and cardiovascular (CV) outcomes for non-obstructive hypertrophic cardiomyopathy (nHCM). We explored these associations using Optum claims and medical record data.
METHODS: Retrospective study of nHCM patients with ≥2 claims (ICD-9/10) at least 30 days apart, 6-months pre- and post-index continuous enrollment (2013-2021). CV outcomes included event rate ratios (RR) for atrial fibrillation (AF), heart failure (HF), stroke, ventricular tachycardia (VT), CV hospitalization (CVH), and CV readmission (CVHR) over a variable follow-up period (index date to death, plan disenrollment, or study end) and Kaplan Meier curve for 3-year all-cause mortality. Outcomes were analyzed by Commercial (reference), Medicare, Medicaid, Other, and Unknown.
RESULTS: Among 9,842 nHCM patients (mean age, 60.6 ± 16.2 years; 46.2% female; 74.2% non-Hispanic White), insurance included 50.0% commercial, 28.4% Medicare, 7.6% Medicaid, 13.6% Unknown, and 0.4% Other. Patients with Medicare had significantly greater rates of AF (RR 1.79), stroke (RR 2.42), HF (RR 2.06), CVH (RR 2.28), and CVHR (RR 1.47) compared to commercial insurance (p<0.001), but lower rate of VT (RR 0.84; p= 0.003). Medicaid had greater rates of stroke (RR 1.95; p<0.001), HF (RR 1.61; p<0.001), SCA (RR 1.89; p= 0.002), CVH (RR 1.57; p<0.001), and CVHR (RR 1.48; p<0.001). Patients with Unknown insurance had greater rates of AF (RR 1.23; p<0.001), stroke (RR 1.36; p<0.001), CVH (RR 1.20; p= 0.004), and CVHR (RR 1.19; p= 0.047), and patients with Other insurance had a greater rate of HF (RR 2.16; p= 0.004). All-cause mortality was highest among Medicare (14.1%; p<0.001), followed by Other (9.1%), Medicaid (6.4%), Unknown (5.2%), and Commercial (4.0%).
CONCLUSIONS: Payer type significantly influences CV outcomes and all-cause mortality in nHCM, with Medicare and Medicaid patients experiencing higher risks. These findings underscore the importance of addressing disparities in care to improve outcomes for nHCM across different payers.
METHODS: Retrospective study of nHCM patients with ≥2 claims (ICD-9/10) at least 30 days apart, 6-months pre- and post-index continuous enrollment (2013-2021). CV outcomes included event rate ratios (RR) for atrial fibrillation (AF), heart failure (HF), stroke, ventricular tachycardia (VT), CV hospitalization (CVH), and CV readmission (CVHR) over a variable follow-up period (index date to death, plan disenrollment, or study end) and Kaplan Meier curve for 3-year all-cause mortality. Outcomes were analyzed by Commercial (reference), Medicare, Medicaid, Other, and Unknown.
RESULTS: Among 9,842 nHCM patients (mean age, 60.6 ± 16.2 years; 46.2% female; 74.2% non-Hispanic White), insurance included 50.0% commercial, 28.4% Medicare, 7.6% Medicaid, 13.6% Unknown, and 0.4% Other. Patients with Medicare had significantly greater rates of AF (RR 1.79), stroke (RR 2.42), HF (RR 2.06), CVH (RR 2.28), and CVHR (RR 1.47) compared to commercial insurance (p<0.001), but lower rate of VT (RR 0.84; p= 0.003). Medicaid had greater rates of stroke (RR 1.95; p<0.001), HF (RR 1.61; p<0.001), SCA (RR 1.89; p= 0.002), CVH (RR 1.57; p<0.001), and CVHR (RR 1.48; p<0.001). Patients with Unknown insurance had greater rates of AF (RR 1.23; p<0.001), stroke (RR 1.36; p<0.001), CVH (RR 1.20; p= 0.004), and CVHR (RR 1.19; p= 0.047), and patients with Other insurance had a greater rate of HF (RR 2.16; p= 0.004). All-cause mortality was highest among Medicare (14.1%; p<0.001), followed by Other (9.1%), Medicaid (6.4%), Unknown (5.2%), and Commercial (4.0%).
CONCLUSIONS: Payer type significantly influences CV outcomes and all-cause mortality in nHCM, with Medicare and Medicaid patients experiencing higher risks. These findings underscore the importance of addressing disparities in care to improve outcomes for nHCM across different payers.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO186
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Rare & Orphan Diseases