SOCIOECONOMIC BURDEN OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN SPAIN: WHEN CHRONIC KIDNEY DISEASE AND INFLAMMATORY RISK CO-OCCUR
Author(s)
Paula Pereira, PhD1, Mariana Pachón-Castro, MSc1, Eloy Vicente Cestero, PhD1, María de San Miguel Marques Vidas, MD2, Paloma Sempere Serrano, MSc3, José Luis Zamorano, MD4, Sara Corredera García, MSc5, Javier Saez Muñoz, MSc6, Elena García, PhD1, Alvaro Hidalgo Vega, PhD1.
1Weber Economía y Salud SL, Madrid, Spain, 2Nephrology department, Hospital Universitario Puerta de Hierro, Madrid, Spain, 3Hospital Pharmacy Department, Complexo Universitario de Santiago de Compostela, Santiago de Compostela, Spain, 4Hospital Ramón y Cajal, Madrid, Spain, 5Heart Failure Unit, Hospital Universitario Severo Ochoa, Madrid, Spain, 6Rehabilitative Services Department, Hospital Universitario de Toledo, Toledo, Spain.
1Weber Economía y Salud SL, Madrid, Spain, 2Nephrology department, Hospital Universitario Puerta de Hierro, Madrid, Spain, 3Hospital Pharmacy Department, Complexo Universitario de Santiago de Compostela, Santiago de Compostela, Spain, 4Hospital Ramón y Cajal, Madrid, Spain, 5Heart Failure Unit, Hospital Universitario Severo Ochoa, Madrid, Spain, 6Rehabilitative Services Department, Hospital Universitario de Toledo, Toledo, Spain.
OBJECTIVES: To estimate the socioeconomic burden of atherosclerotic cardiovascular disease (ASCVD) in Spain in a high-risk and overlooked group with concomitant chronic kidney disease (CKD) and inflammatory risk (IR) from a full societal perspective.
METHODS: A probabilistic model was developed to simulate the natural history of ASCVD+CKD+IR over a 5-year horizon in two age cohorts (40-64 and ≥65 years). IR was defined as high-sensitivity C-reactive protein (hs-CRP) ≥2 mg/L. The model included baseline disease management and acute events: MACE (stroke, myocardial infarction); heart failure hospitalization; acute kidney failure; renal replacement therapy; revascularization; severe infection; cardiovascular death. Spanish prevalence data were obtained from published literature. Direct costs were estimated using a bottom-up approach with a 126% uplift applied to basal management to capture CKD+IR comorbidity impact. Indirect costs (sick leave, permanent disability), health-related quality-of-life losses (EQ-5D; threshold €30,500/QALY), and intangible costs were incorporated. Sensitivity analyses applied public primary attention database-derived prevalence to ensure minimum-cost scenario. Inputs were validated by a multidisciplinary committee.
RESULTS: Total socio-economic burden was estimated at almost €50 billion. Initial management costs in the first year accounted for €21.1 billion, while event-related costs accumulated over 5 years reached €27.2 billion, indicating that long-term burden is mainly driven by the accumulation of events over time. General management costs were primarily direct costs (78%). In the 40-64 subgroup, indirect costs account for 7% of first-year management costs and premature cardiovascular death entailed mean productivity losses of €395,825 per person. In patients aged ≥65 years, direct costs account for 84% of management costs.
CONCLUSIONS: RI and CKD act as key cost multipliers in ASCVD patients imposing a substantial and likely underestimated socioeconomic burden in Spain. Early identification and management of IR in this high-risk profile is crucial to reduce preventable events and system costs.
METHODS: A probabilistic model was developed to simulate the natural history of ASCVD+CKD+IR over a 5-year horizon in two age cohorts (40-64 and ≥65 years). IR was defined as high-sensitivity C-reactive protein (hs-CRP) ≥2 mg/L. The model included baseline disease management and acute events: MACE (stroke, myocardial infarction); heart failure hospitalization; acute kidney failure; renal replacement therapy; revascularization; severe infection; cardiovascular death. Spanish prevalence data were obtained from published literature. Direct costs were estimated using a bottom-up approach with a 126% uplift applied to basal management to capture CKD+IR comorbidity impact. Indirect costs (sick leave, permanent disability), health-related quality-of-life losses (EQ-5D; threshold €30,500/QALY), and intangible costs were incorporated. Sensitivity analyses applied public primary attention database-derived prevalence to ensure minimum-cost scenario. Inputs were validated by a multidisciplinary committee.
RESULTS: Total socio-economic burden was estimated at almost €50 billion. Initial management costs in the first year accounted for €21.1 billion, while event-related costs accumulated over 5 years reached €27.2 billion, indicating that long-term burden is mainly driven by the accumulation of events over time. General management costs were primarily direct costs (78%). In the 40-64 subgroup, indirect costs account for 7% of first-year management costs and premature cardiovascular death entailed mean productivity losses of €395,825 per person. In patients aged ≥65 years, direct costs account for 84% of management costs.
CONCLUSIONS: RI and CKD act as key cost multipliers in ASCVD patients imposing a substantial and likely underestimated socioeconomic burden in Spain. Early identification and management of IR in this high-risk profile is crucial to reduce preventable events and system costs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE164
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Urinary/Kidney Disorders