OBJECTIVES: Atherosclerosis cardiovascular disease (ASCVD) which comprises various subtypes, including myocardial infarction (MI), ischemia stroke (IS), unstable angina (UA), and revascularization is the leading cause of death and disability worldwide and incurs substantial healthcare costs. However, little is known about whether the economic burden of ASCVD vary by its subtypes and over time in Asian settings. We therefore seek to quantify the cost impact of various ASCVD over time from Taiwan’s healthcare system perspective.

METHODS: This retrospective cohort study identified the patients with established ASCVD from the Taiwan’s National Health Insurance Database during 2018-2022. Crude healthcare costs including acute care episode cost, event-year cost (reflecting the healthcare management/utilization within 1^st year when the event occurred) and state-year cost (reflecting the annual resource use required beyond the 1^st year of the event occurrence) attributable to individual ASCVD subtype were estimated, and associated cost impacts were determined using multivariable generalized estimating equations models with adjustment of individual characteristics. Indirect costs which consider individual productivity loss due to ASCVD occurrence was estimated using human capital approach.

RESULTS: There were 1,389 ASCVD patients in 2018 analyzed, with an average age of 60.1 years, 79% male, and 38.4% having diabetes. Patients having ASCVD occurred in the past one year, 2^nd year, and more over 2 years ago account for 44%, 31%, and 25% of study cohort, respectively. The crude event rates (/100,000 person-year) and acute care episode cost (in 2023 USD) were 4.2 and $6,168 for MI, 4.7 and $2,496 for IS, 4.9 and $847 for UA, and 17.3 and $5,617 for revascularization, respectively.

CONCLUSIONS: This study is expected to provide comprehensive estimates of the economic burden due to ASCVD and its subtypes in modern real-world settings, which are useful for clinical care, resource allocation, and economic simulation models to identify cost-effective interventions.