Medical resource use and costs associated with chylomicronemia

Abstract

Background:

The prevalence of severe hypertriglyceridemia (TG > 1000 mg/dl) is estimated at 150–400 per 100,000 individuals in North America. Severe hypertriglyceridemia in the fasting state is associated with increased acute pancreatitis risk and is a sign of chylomicronemia which reflects the accumulation in the bloodstream of chylomicrons, the large lipoprotein particles produced in the gut after a meal.

Objective:

To assess medical resource use and costs associated with chylomicronemia.

Methods:

Patients with chylomicronemia of different causes (≥2 diagnoses with ICD-9 code 272.3) were identified from a large US claims database (years 2000 to 2009) and matched 1:1 to controls free of chylomicronemia based on age, gender, demographics, comorbidities, and use of lipid lowering drugs. During a 1-year study period, medical resource use and costs associated with chylomicronemia or acute pancreatitis were compared between matched cases and controls.

Results:

Among 6472 matched pairs, annual per-patient medical costs, calculated independently of the occurrence of acute pancreatitis, were significantly greater by $808 for chylomicronemia cases vs controls ($8029 vs $7220, p < 0.01), half of which was attributable to chylomicronemia-related services (p < 0.01). Chylomicronemia cases with a history of acute pancreatitis (n = 46) had greater rates of inpatient visits (p < 0.05) and greater average costs for subsequent acute pancreatitis or abdominal pain (p < 0.01) as well as greater total medical costs ($33,587 vs $4402, p < 0.01) vs matched controls. The average episode of acute pancreatitis (n = 104 episodes) generated medical costs of $31,820, almost entirely due to inpatient stays.

Limitations:

Triglyceride levels were not available to characterize disease severity.

Conclusions:

Patients with chylomicronemia, and especially those with a history of acute pancreatitis, incurred significantly greater total medical costs compared with individuals without chylomicronemia but with an otherwise comparable health profile.

Keywords::

• Chylomicronemia
• Familial chylomicronemia syndrome
• Cost of illness
• Economics
• Acute pancreatitis

Transparency

Declaration of funding

Novartis Pharmaceuticals Corporation provided financial support for this study.

Declaration of financial/other relationships

Daniel Gaudet held the Canada Research Chair in preventive genetics and community genomics (www.chairs.gc.ca), which is supported by a CIHR team grant (# CTP-82941). Karine Tremblay is a Université de Montréal post-doctoral and CCRP fellow and receives grant support from the Canadian Heart and Stroke Foundation. Diane Brisson has no relevant financial relationships to disclose. During the study, James Signorovitch, Elyse Swallow, and Liangyi Fan are salaried employees of Analysis Group, Inc., which received funding from Novartis for this study. Charles Meyers and Jean-Bernard Gruenberger have disclosed that they are employees of Novartis and own stock in the company. JME Peer Reviewers on this manuscript have no relevant financial relationships to disclose.