INCREASING HEALTHCARE RESOURCE UTILIZATION WITH RECURRENT ASCVD EVENTS AND SUBOPTIMAL LDL-C MANAGEMENT
Author(s)
Moshe Hoshen, PhD1, Michal Goldberg, PhD1, Vishal Bali, MS, PhD2, Sarah Sharman Moser, MSc1, Lori Bash, PhD2, Thibaut Galvain, PhD2, Ran Numa, PhD3, Tal Patalon, MD1, Mohamed Safwat, MPH4, Gazit Sivan, MD1, Alberico Catapano, MD5.
1Maccabi Healthcare Services, Tel Aviv, Israel, 2Merck & Co., Inc., Rahway, NJ, USA, 3MSD Company Ltd, Hod Hasharon, Israel, 4MSD IDEA Middle East, Dubai, United Arab Emirates, 5University of Milan & Multimedica IRCCS, Milan, Italy.
1Maccabi Healthcare Services, Tel Aviv, Israel, 2Merck & Co., Inc., Rahway, NJ, USA, 3MSD Company Ltd, Hod Hasharon, Israel, 4MSD IDEA Middle East, Dubai, United Arab Emirates, 5University of Milan & Multimedica IRCCS, Milan, Italy.
OBJECTIVES: Patients with atherosclerotic cardiovascular disease (ASCVD) carry increased risk for recurrent events, which may elevate healthcare utilisation. However, variation in healthcare costs by the number and type of recurring ASCVD events is poorly quantified. This study assessed annual all-cause healthcare costs associated with recurrent and multibed ASCVD.
METHODS: This retrospective cohort study used deidentified electronic health records from Maccabi Health Services, a nationwide integrated healthcare provider in Israel. Adults aged 40-79 years with a first non-fatal ASCVD event—including myocardial infarction (MI), ischemic stroke (IS), carotid endarterectomy (CE), or peripheral artery disease (PAD)—during 2006-2022 were included. Follow-up began after first ASCVD event and continued until death, disenrollment, or December 31, 2023. Annual all-cause healthcare costs were modeled using gamma regression adjusting for sociodemographic, clinical, and comorbidity factors.
RESULTS: The cohort included 25,285 adults with 30,422 ASCVD events over a median follow-up of 4.6 years; mean age at first event was 61 years (SD=9.8) and 15% died during follow-up. Compared to patients after first MI (N=15,366), annual costs increased with recurrent MI (Incidence Rate Ratio (IRR) = 1.24, after second MI, N=2,215; IRR = 1.41, for ≥3 MI, N=441), recurrent IS (≥2 IS events IRR = 1.34, N=943) and PAD (IRR = 1.47, N=1,649), all p<0.001. CE was associated with lower costs (IRR = 0.86; N=1,085) and highest costs were observed with multi-bed ASCVD (IRR = 1.86; N=1,563), both p<0.001. When compared to LDL-C level of 70-<100 mg/dL, LDL-C of <55 mg/dL and 55-<70 mg/dL were associated with lower cost (IRR = 0.87; N=1,583 for <55 mg/dL; IRR = 0.80; N=2,318 for 55-<70 mg/dL) both p<0.001. Older age, female sex, lower SES, hypertension, diabetes, cancer and smoking were independently associated with increased costs (all p<0.001).
CONCLUSIONS: Healthcare costs increased with both recurrent and multi-bed ASCVD, and suboptimal LDL-C management underscoring the need for more effective secondary prevention strategies to improve outcomes and reduce costs.
METHODS: This retrospective cohort study used deidentified electronic health records from Maccabi Health Services, a nationwide integrated healthcare provider in Israel. Adults aged 40-79 years with a first non-fatal ASCVD event—including myocardial infarction (MI), ischemic stroke (IS), carotid endarterectomy (CE), or peripheral artery disease (PAD)—during 2006-2022 were included. Follow-up began after first ASCVD event and continued until death, disenrollment, or December 31, 2023. Annual all-cause healthcare costs were modeled using gamma regression adjusting for sociodemographic, clinical, and comorbidity factors.
RESULTS: The cohort included 25,285 adults with 30,422 ASCVD events over a median follow-up of 4.6 years; mean age at first event was 61 years (SD=9.8) and 15% died during follow-up. Compared to patients after first MI (N=15,366), annual costs increased with recurrent MI (Incidence Rate Ratio (IRR) = 1.24, after second MI, N=2,215; IRR = 1.41, for ≥3 MI, N=441), recurrent IS (≥2 IS events IRR = 1.34, N=943) and PAD (IRR = 1.47, N=1,649), all p<0.001. CE was associated with lower costs (IRR = 0.86; N=1,085) and highest costs were observed with multi-bed ASCVD (IRR = 1.86; N=1,563), both p<0.001. When compared to LDL-C level of 70-<100 mg/dL, LDL-C of <55 mg/dL and 55-<70 mg/dL were associated with lower cost (IRR = 0.87; N=1,583 for <55 mg/dL; IRR = 0.80; N=2,318 for 55-<70 mg/dL) both p<0.001. Older age, female sex, lower SES, hypertension, diabetes, cancer and smoking were independently associated with increased costs (all p<0.001).
CONCLUSIONS: Healthcare costs increased with both recurrent and multi-bed ASCVD, and suboptimal LDL-C management underscoring the need for more effective secondary prevention strategies to improve outcomes and reduce costs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE163
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas