title: Work productivity loss and indirect costs associated with new cardiovascular events in high-risk patients with hyperlipidemia: estimates from population-based register data in Sweden.
abstract: OBJECTIVE
  To estimate productivity loss and associated indirect costs in high-risk patients treated for hyperlipidemia who experience cardiovascular (CV) events.
  
  
  METHODS
  Retrospective population-based cohort study conducted using Swedish medical records linked to national registers. Patients were included based on prescriptions of lipid-lowering therapy between 1 January 2006 and 31 December 2011 and followed until 31 December 2012 for identification of CV events and estimation of work productivity loss (sick leave and disability pension) and indirect costs. Patients were stratified into two cohorts based on CV risk level: history of major cardiovascular disease (CVD) and coronary heart disease (CHD) risk equivalent. Propensity score matching was applied to compare patients with new events (cases) to patients without new events (controls). The incremental effect of CV events was estimated using a difference-in-differences design, comparing productivity loss among cases and controls during the year before and the year after the cases' event.
  
  
  RESULTS
  The incremental effect on indirect costs was largest in the CHD risk equivalent cohort (n = 2946) at €3119 (P value <0.01). The corresponding figure in the major CVD history cohort (n = 4508) was €2210 (P value <0.01). There was substantial variation in productivity loss depending on the type of event. Transient ischemic attack and revascularization had no significant effect on indirect costs. Myocardial infarction (€3465), unstable angina (€2733) and, most notably, ischemic stroke (€6784) yielded substantial incremental cost estimates (P values <0.01).
  
  
  CONCLUSIONS
  Indirect costs related to work productivity losses of CV events are substantial in Swedish high-risk patients treated for hyperlipidemia and vary considerably by type of event.
authors.affiliation: Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden. jonas.banefelt@quantifyresearch.com.
authors.forename: J
authors.initials: J
authors.lastname: Banefelt
authors.affiliation: Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Hallberg
authors.affiliation: Strategic Healthcare Solutions, LLC, Baltimore, MD, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Fox
authors.affiliation: Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden.|LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Mesterton
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Paoli
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Johansson
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: L-Å
authors.initials: LÅ
authors.lastname: Levin
authors.affiliation: LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden.|IMS Health, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Sobocki
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Gandra
mesh_terms: D000328:Adult; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000191:economics*; D017281:Cost of Illness; D004526:Efficiency; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010415:Pensions; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D018582:Sick Leave; D013548:Sweden; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents
keywords: Cardiovascular disease; Hyperlipidemia; Indirect costs; Productivity