HEALTHCARE UTILIZATION, COSTS, AND MORTALITY BY NYHA CLASS IN PATIENTS WITH OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY IN SWEDEN
Author(s)
Anna Damlin, PhD1, Christina Christersson, PhD2, Oscar Braun, PhD3, Johan Rehnberg, PhD4, Ling Zhu, MSc4, Ebba Gregory, PharmD, PhD5, Maria Ulvestad, PhD6, Anna Sundin, PhD5.
1Department of Molecular Medicine and Surgery, Karolinska Insitutet, Stockholm, Sweden, 2Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden, 3Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden, 4Medaffcon AB, Stockholm, Sweden, 5Bristol Myers Squibb, Stockholm, Sweden, 6Bristol-Myers Squibb, Lysaker, Norway.
1Department of Molecular Medicine and Surgery, Karolinska Insitutet, Stockholm, Sweden, 2Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden, 3Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden, 4Medaffcon AB, Stockholm, Sweden, 5Bristol Myers Squibb, Stockholm, Sweden, 6Bristol-Myers Squibb, Lysaker, Norway.
OBJECTIVES: Obstructive hypertrophic cardiomyopathy (oHCM) involves left ventricular outflow tract obstruction and is associated with substantial symptoms and healthcare needs. Disease severity is commonly assessed using New York Heart Association (NYHA) class. This study estimated direct and indirect healthcare utilization, costs, and mortality among Swedish patients with oHCM stratified by NYHA class.
METHODS: National register data and patient records were used to identify Swedish adults (≥18 years) diagnosed with oHCM (I42.1) between 2007-2024 and followed from 2012-2024. Analyses were restricted to patients with available NYHA class information from Uppsala and Karolinska University Hospitals. Direct costs were estimated from healthcare contacts using diagnosis related group (DRG) prices, and indirect costs from income loss due to sick leave and early retirement. Utilization and costs were analysed using mean cumulative functions by time-varying NYHA class (I, II, and III-IV). Mortality risk among incident patients was estimated using age- and sex-adjusted Cox regression with time-varying NYHA class (I-II vs III-IV).
RESULTS: Among 407 oHCM patients with NYHA data, 49.4% were men; median age at diagnosis was 64 years (IQR 53-72), and 53.8% were aged 18-65. Distribution across latest recorded NYHA class was 10.1%, 31.0%, 58.7%, and 0.2% (I-IV). Healthcare utilization (outpatient visits and hospitalisations) and costs increased with worsening NYHA class. Mean cumulative healthcare costs per patient-year (in Swedish kronor, SEK) were 57,576 (95% CI 30,338-84,814), 61,123 (43,162-79,083), and 100,983 (85,678-116,287) for NYHA I, II, III-IV, respectively. Costs exceeded reported annual levels for Swedish adults aged 65-69 (~30,000 SEK). Indirect costs also increased with higher NYHA class. Mortality was higher in NYHA III-IV vs I-II (HR 3.16, 95% CI 1.23-8.10, p=0.017).
CONCLUSIONS: oHCM patients showed higher healthcare utilization and costs than reported levels in the age-matched Swedish population, and both increased with worsening NYHA class. These findings indicate an association between disease severity and clinical and economic outcomes.
METHODS: National register data and patient records were used to identify Swedish adults (≥18 years) diagnosed with oHCM (I42.1) between 2007-2024 and followed from 2012-2024. Analyses were restricted to patients with available NYHA class information from Uppsala and Karolinska University Hospitals. Direct costs were estimated from healthcare contacts using diagnosis related group (DRG) prices, and indirect costs from income loss due to sick leave and early retirement. Utilization and costs were analysed using mean cumulative functions by time-varying NYHA class (I, II, and III-IV). Mortality risk among incident patients was estimated using age- and sex-adjusted Cox regression with time-varying NYHA class (I-II vs III-IV).
RESULTS: Among 407 oHCM patients with NYHA data, 49.4% were men; median age at diagnosis was 64 years (IQR 53-72), and 53.8% were aged 18-65. Distribution across latest recorded NYHA class was 10.1%, 31.0%, 58.7%, and 0.2% (I-IV). Healthcare utilization (outpatient visits and hospitalisations) and costs increased with worsening NYHA class. Mean cumulative healthcare costs per patient-year (in Swedish kronor, SEK) were 57,576 (95% CI 30,338-84,814), 61,123 (43,162-79,083), and 100,983 (85,678-116,287) for NYHA I, II, III-IV, respectively. Costs exceeded reported annual levels for Swedish adults aged 65-69 (~30,000 SEK). Indirect costs also increased with higher NYHA class. Mortality was higher in NYHA III-IV vs I-II (HR 3.16, 95% CI 1.23-8.10, p=0.017).
CONCLUSIONS: oHCM patients showed higher healthcare utilization and costs than reported levels in the age-matched Swedish population, and both increased with worsening NYHA class. These findings indicate an association between disease severity and clinical and economic outcomes.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD103
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas