Healthcare resource utilization and costs of cardiovascular events in patients with atherosclerotic cardiovascular disease in Germany – results of a claims database study

Abstract

Objectives

We assessed healthcare resource utilization (HCRU) and costs of cardiovascular (CV) events in patients with a history of atherosclerotic cardiovascular disease (ASCVD) in Germany.

Methods

We conducted a retrospective matched case-control study based on German claims data from 1 January 2012 to 31 December 2017 using the “Institute for Applied Health Research Berlin” (InGef) Research Database. Cases who had a myocardial infarction (MI), stroke and angina pectoris identified by ICD-10-GM codes between 1 January 2014 and 31 December 2016 were matched to event-free controls by an exact matching approach without replacement at a ratio of 1:2. Costs and HCRU were assessed in individual 1-year follow-up periods after the index event for the overall cohort and subgroups of MI cases and stroke cases.

Results

The overall cohort consisted of a total of 14,169 cases with a CV index event matched to 28,338 controls. The mean age of the overall cohort was 73.3 years, 34.1% of the patients were female, 3,717 (26.2%) had an MI, and 3,752 (26.5%) had stroke. Following the index events, 12.2% of cases in the overall cohort, 12.6% of MI cases, and 8.7% of stroke cases experienced a recurrent CV event. CV cases had on average 1.7 more all-cause hospitalizations (p <0.001) and 6.1 more outpatient visits (p <0.001) during the 1-year follow-up period than did controls. In the MI and stroke subgroups, cases had on average 1.8 and 1.6 more all-cause hospitalizations and 7.0 and 4.0 more outpatient visits, respectively (differences were statistically significant). Compared to controls, cases incurred on average higher total healthcare costs: by €11,898 for overall cases, by €16,349 for MI, and by €14,360 in stroke cases (overall: p <0.001; MI: p <0.001; stroke: p <0.001).

Conclusion

CV events in ASCVD patients pose a considerable clinical burden on patients and cause significant costs for the German statutory healthcare system.

Keywords:

• Atherosclerotic cardiovascular disease
• myocardial infarction
• stroke
• Angina pectoris
• healthcare costs
• healthcare resource utilization
• claims data

Transparency

Declaration of funding

This work was supported by Amgen Inc, Thousand Oaks, CA, USA.

Declaration of financial/other relationships

ED was an employee of Amgen GmbH at the time of the study and holds stock of Amgen Inc. ES is an employee of Amgen (Europe) GmbH and holds stock of Amgen Inc. LP was an employee of Amgen Inc at the time of the study and holds stock of Amgen Inc. CJ and CM are employees of Xcenda GmbH, who received funds from Amgen Inc to conduct the study. RL reports consultancy fees from Amgen. The authors declare that no further conflict of interest exists. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conception, design or planning of the study: Eduard Sidelnikov, Eugen Dornstauder, Christian Jacob, Christopher Maas, Lionel Pinto. Acquisition of the data: Christian Jacob, Christopher Maas. Analysis of the data: Eduard Sidelnikov, Eugen Dornstauder, Christian Jacob, Christopher Maas. Interpretation of the results: Eduard Sidelnikov, Eugen Dornstauder, Christian Jacob, Christopher Maas, Lionel Pinto, Reiner Leidl, Ingo Ahrens. Drafting of the manuscript: Eduard Sidelnikov, Christian Jacob, Christopher Maas. Critically reviewing or revising the manuscript for important intellectual content: Eugen Dornstauder, Lionel Pinto, Reiner Leidl, Ingo Ahrens.

Acknowledgements

The analyses were performed in collaboration with Prof. Dr. Wolfgang Greiner and the Institute for Applied Health Research Berlin (InGef).

Data availability statement

The data used in this study cannot be made available in the manuscript, the supplemental files, or in a public repository due to German data protection laws (Bundesdatenschutzgesetz). To facilitate the replication of results, anonymized data used for this study are stored on a secure drive at the Institute for Applied Health Research Berlin (InGef). Access to the data used in this study can only be provided to external parties under the conditions of the cooperation contract of this research project and can be assessed upon request, after written approval ([email protected]), if required.