title: Healthcare resource utilization and costs in working-age patients with high-risk atherosclerotic cardiovascular disease: findings from a multi-employer claims database.
abstract: OBJECTIVE
  Patients with coronary artery disease with diabetes, a history of acute coronary syndromes, cerebrovascular atherosclerotic disease, or peripheral arterial disease are at particularly high risk for a cardiovascular (CV) event and can be defined as having high-risk atherosclerotic cardiovascular disease (ASCVD). The objective of this study is to examine healthcare resource utilization (HRU) and total healthcare costs (THC) for patients with ASCVD in a commercially insured population.
  
  
  METHODS
  A retrospective cohort study was conducted using a large, US employer-based, claims database. Patients with an ASCVD diagnosis between October 1, 2008 to September 30, 2009 who met eligibility requirements were included. All-cause and ASCVD-related HRU and THC for the first and second year of follow-up were examined for all patients and by the number of arterial beds affected. Adjusted THC were compared across groups with and without polyvascular disease.
  
  
  RESULTS
  The analysis included 152,290 patients with ASCVD. Use of CV-related medications, hospitalizations, and office visits were highest among patients with three arterial beds affected. Mean all-cause THC for patients with ASCVD were ∼$19,000 per patient in Year 1 or Year 2, with medical costs as the main driver. ASCVD-related THC were also similar for Year 1 ($8699) and Year 2 ($7925) across all patients. Adjusted all-cause and ASCVD-related THC for both years were greatest for patients with three affected arterial beds compared with one or two affected beds (p < 0.001 for each comparison).
  
  
  CONCLUSIONS
  This is the first study in a managed care setting to systematically estimate all-cause and ASCVD-related THC for an aggregated population of ASCVD patients at high risk for a CV event. The economic burden of ASCVD in working-age patients in the US is substantial. Significantly higher HRU and costs were found in patients with polyvascular disease compared with those with only one affected bed.
authors.affiliation: a a Eli Lilly and Company , Indianapolis , IN , USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Zhao
authors.forename: Y
authors.initials: Y
authors.lastname: Zhu
authors.forename: Y
authors.initials: Y
authors.lastname: Fang
authors.forename: W
authors.initials: W
authors.lastname: Ye
authors.forename: P
authors.initials: P
authors.lastname: McCollam
mesh_terms: D054058:Acute Coronary Syndrome / Q000191:economics* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis / Q000191:economics* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D002537:Intracranial Arteriosclerosis / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009819:Office Visits / Q000191:economics; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D058729:Peripheral Arterial Disease / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Atherosclerotic cardiovascular disease; Commercial payer; Cost; Resource use