COST ANALYSIS OF LIPID GOAL ATTAINMENTS AND THEIR RELATIONSHIP WITH CLINICAL OUTCOMES IN CHINESE POST-PERCUTANEOUS CORONARY INTERVENTION ACUTE CORONARY SYNDROME PATIENTS
Author(s)
Lee VW1, Wang Y2, Yan BP2, Tomlinson B2, Nichol MB3
1The Chinese University of Hong Kong, Hong Kong, Hong Kong, 2The Chinese University of Hong Kong, Shatin, Hong Kong, 3University of Southern California, Los Angeles, CA, USA
OBJECTIVES： The guidelines-recommend low-density lipoprotein cholesterol (LDL-C) levels for patients may perform relatively well in white patients, but it may not work for other ethnic groups. Trial and observational data are lacking for Chinese patients. The objective of this research was to investigate the relationship of lipid goal attainments with clinical benefits and cost of care for Chinese patients. METHODS : A cohort study was conducted in an acute public hospital in Hong Kong, enrolling acute coronary syndrome (ACS) patients who received percutaneous coronary intervention (PCI) between January 2005, and November 2015. The primary outcomes of interest were the total costs of medical care and cardiovascular-related cost during one-year follow-up. The cost difference by lipid goal attainments was analyzed by the Poisson regression with multivariate treatment effects, adjusting for age, sex, diabetes, hypertension, and prior CVD history. The clinical benefits in terms of reduction in major adverse cardiovascular events (MACEs) achieved by the lipid goals were analyzed by multivariable Cox regression analyses. RESULTS : Of the patients identified in the database, 4638 patients with at least one cholesterol measurement during the year were included in the analysis. Of these 36.14%, 48.64%, and 79.50% attained the LDL-C goal of <2.6mmol/L, <2.0mmol/L and <1.8mmol/L at one year, respectively. Of 4182 patients with baseline LDL-C, merely 16% patients achieved the 50% reduction from baseline. None of these lipid goals was associated with reduction in total medical care costs within one-year follow-up. We merely identify the clinical benefits associated with lipid goals of <2.6mmol/L. The stringent lipid goals of <1.8mmol/L, 50% LDL-C reduction, and <2.0mmol/L led to significant economic burden on cardiovascular-related cost, but their clinical benefits were uncertain. CONCLUSIONS : Lowering LDL-C to achieve guideline-recommended target levels for post-PCI ACS patients may lead to fewer cardiovascular events, but it may not necessarily lead to economic benefits within one-year follow-up.
Conference/Value in Health Info
2018-05, ISPOR 2018, Baltimore, MD, USA
Value in Health, Vol. 21, S1 (May 2018)
Code
PCV37
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders