Productivity loss as a major component of disease-related costs in patients with hypercholesterolemia in Germany.
OBJECTIVE
Hypercholesterolemia is a common risk factor for cardiovascular diseases; however, there are only few data available on associated costs. The objective of this study is, therefore, to analyse direct and indirect costs in patients with hypercholesterolemia and to determine predictors of costs.


METHODS
The ORBITAL Study is a randomised controlled trial evaluating the effectiveness of a compliance-enhancing program in patients with statin therapy. Consecutive patients eligible for statin therapy according to the Joint European Guidelines were enrolled nationwide in 1961 primary care practices in Germany. For the present cost-of-illness analysis, patients were asked retrospectively about medical resource use and employment status in the 6 months preceding enrollment. The perspective chosen was societal. Factors associated with costs were determined using linear regression.


RESULTS
A total of 7,640 patients (56% men, mean age 60 +/- 10 years, and 44% women, 64 +/- 10 years) were included. Of these patients, 32% were employed, 17% had a history of myocardial infarction, 7% a history of stroke, 58% had hypertension, and 29% diabetes. Total disease-related costs amounted to a mean of 2,498 +/- 4,898 Euros per patient over 6 months, comprising direct (44%) and indirect (56%) costs. Disease-related early retirement was responsible for 42% of costs, followed by hospital visits (19%), medication (15%), workdays lost (14%), physician visits (5%), outpatient therapy (2%), and rehabilitation (2%). In multivariable analyses, factors associated with direct costs included coronary interventions, risk stratum, and medical history. Factors associated with indirect costs included disease-related early retirement, other socio-economic and lifestyle factors, coronary interventions, risk stratum, and medical history.


CONCLUSIONS
The considerable economic burden associated with hypercholesterolemia indicates the need to assess long-term cost-effectiveness of health care programs in patients with this disorder.
Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, 10098, Berlin, Germany. jacqueline.mueller-nordhorn@charite.de
Jacqueline
J
Müller-Nordhorn
Heike
H
Englert
Karl
K
Wegscheider
Hendrike
H
Berger
Frank
F
Sonntag
Heinz
H
Völler
Wolfgang
W
Meyer-Sabellek
Thomas
T
Reinhold
Eberhard
E
Windler
Hugo A
HA
Katus
Stefan N
SN
Willich
D016507:Cardiology Service, Hospital / Q000191:economics*; D002318:Cardiovascular Diseases / Q000191:economics* / Q000517:prevention & control; D003365:Costs and Cost Analysis; D004526:Efficiency; D005260:Female; D005858:Germany; D006801:Humans; D006937:Hypercholesterolemia / Q000191:economics* / Q000517:prevention & control; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D012179:Retirement / Q000191:economics; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires