title: Clinical and economic outcomes in a real-world population of patients with elevated triglyceride levels.
abstract: OBJECTIVE
  This study investigated real-world treatment patterns, healthcare utilization, and costs of hypertriglyceridemia in a large commercially insured United States population.
  
  
  METHODS
  This observational claims study was conducted among adult patients with TG > 500 mg/dL between 01/01/2007 and 04/30/2013. Patients were stratified into mutually exclusive cohorts based on their first available TG measurement (index date): TG ≥ 1500 (Cohort A); 750 ≤ TG < 1500 (Cohort B), and 500 < TG < 750 (Cohort C). Study inclusion required ≥ 12 months of eligibility pre- (baseline) and post-index date (follow-up). Patient characteristics and outcomes were assessed descriptively. Costs associated with acute pancreatitis episodes were estimated using a Generalized Linear Model regression.
  
  
  RESULTS
  We identified a total of 1964 patients in Cohort A, 7432 in Cohort B, and 17,500 in Cohort C. Patients were young (mean age 46-48) and mostly male (75%-80%). Treatment switching and augmentation occurred rarely, and almost 50% of patients discontinued their initial treatment. At baseline, healthcare utilization and costs were highest in Cohort A (mean all-cause medical and pharmacy costs, $8850). At follow-up, the number of patients with dyslipidemia-related office and pharmacy claims and related costs almost doubled across the cohorts. Mean all-cause costs/patient in Cohort A at follow-up were $12,642, of which $3730 were dyslipidemia-related. Acute pancreatitis episodes were associated with >300% increase in total all-cause costs in Cohort A.
  
  
  CONCLUSIONS
  These results suggest that severe hypertriglyceridemia is undertreated and healthcare utilization and costs scale with magnitude of TG elevation. Patients with more severe hypertriglyceridemia received greater medical and pharmacy services. Managing severe hypertriglyceridemia more aggressively and preventing acute pancreatitis may generate cost savings.
authors.affiliation: CGH Medical Center, Sterling, IL, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: Peter.Toth@cghmc.com.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.affiliation: HealthCore, Inc., Wilmington, DE, USA. Electronic address: mgrabner@healthcore.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Grabner
authors.affiliation: Rutgers University, School of Health Related Professions, Newark, NJ, USA; ESAC Inc., Rockville, MD, USA. Electronic address: nadia.ramey@gmail.com.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ramey
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. Electronic address: keiko.higuchi@novartis.com.
authors.forename: Keiko
authors.initials: K
authors.lastname: Higuchi
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000150:complications / Q000191:economics; D048909:Diabetes Complications / Q000097:blood; D005260:Female; D058607:Fibric Acids / Q000737:chemistry; D017048:Health Care Costs; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood* / Q000191:economics*; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010195:Pancreatitis / Q000150:complications / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*; D014481:United States
chemical_list: D058607:Fibric Acids; D014280:Triglycerides
keywords: Fibrate; Health care costs; Health outcomes; Health services research; Hypertriglyceridemia; Pancreatitis; Statin; Treatment patterns