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

Figures & data

Table 1. Baseline characteristics of the overall matched study cohorts.

Overall cohort	Cases (N = 14,169)	Controls (N = 28,338)	Standardized mean difference
Age (years); mean (SD)	73.3 (9.3)	73.3 (9.3)	0.0
Sex (female); n (%)	4,826 (34.1)	9,652 (34.1)	0.0
CCI score (in a 1-year pre-index period); mean (SD)	2.3 (2.0)	2.0 (1.9)	15.4
Index CV event distribution
MI; n (%)	3,717 (26.2)	N/A	N/A
Stroke; n (%)	3,752 (26.5)	N/A	N/A
Angina pectoris; n (%)	6,700 (47.3)	N/A	N/A
History of ASCVD
MI; n (%)	2,108 (14.9)	4,216 (14.9)	0.0
Hospitalization for angina pectoris; n (%)	2,191 (15.5)	2,899 (10.2)	15.9
Stroke; n (%)	2,287 (16.1)	4,574 (16.1)	0.0
Transient ischemic attack; n (%)	1,304 (9.2)	2,726 (9.6)	1.4
Peripheral arterial disease; n (%)	7,210 (50.9)	14,420 (50.9)	0.0
Coronary revascularization; n (%)	4,373 (30.9)	8,746 (30.9)	0.0
Other ASCVD; n (%)	10,251 (72.3)	20,502 (72.3)	0.0
Additional risk factors
Smoking; n (%)	1,794 (12.7)	3,534 (12.5)	0.0
Hypertension; n (%)	13,309 (93.9)	26,542 (93.7)	0.8
Diabetes mellitus; n (%)	6,916 (48.8)	13,378 (47.2)	3.2
Chronic kidney disease; n (%)	2,729 (19.3)	5,226 (18.4)	2.3
Disorders of lipoprotein metabolism and other lipidemias; n (%)	12,733 (89.9)	25,787 (91.0)	3.7
Obesity; n (%)	4,041 (28.5)	8,766 (30.9)	5.3
Heart failure; n (%)	4,440 (31.3)	8,691 (30.7)	1.3

Abbreviations: ASCVD, atherosclerotic cardiovascular disease; CCI, Charlson comorbidity index; MI, myocardial infarction; SD, standard deviation; N/A, not applicable.

Matching parameters were considered balanced by a standardized difference below the 0.1 mark, which was achieved for all included parameters.

Note: The CCI score preceding the index event was not included in the matching process.

Table 2. Baseline characteristics of the matched subgroups.

MI subgroup
	Cases (N = 3,717)	Controls (N = 7,434)	Standardized mean difference
Age (years); mean (SD)	73.8 (9.4)	73.8 (9.4)	0.0
Sex (female); n (%)	1,152 (31.0)	2,304 (31.0)	0.0
CCI score (in a 1-year pre-index period); mean (SD)	2.4 (2.1)	2.1 (1.9)	15.0
Recurrent events of MI subgroup
Number of myocardial infarction events; n (%)	242 (42.0)	N/A	N/A
Number of stroke events; n (%)	48 (8.3)	N/A	N/A
Number of angina pectoris events; n (%)	286 (49.7)	N/A	N/A
Total number of recurrent CV events; n (%)	576 (100.0)	N/A	N/A
Number of patients with myocardial infarctions; n (%)	194 (5.2)	N/A	N/A
Number of patients with strokes; n (%)	43 (1.2)	N/A	N/A
Number of patients with angina pectoris; n (%)	233 (6.3)	N/A	N/A
Distinct number of patients with recurrent CV event; n (%)	470 (12.6)	N/A	N/A
Stroke subgroup
	Cases (N = 3,752)	Controls (N = 7,504)	Standardized mean difference
Age (years); mean (SD)	76.7 (8.5)	76.7 (8.5)	0.0
Sex (female); n (%)	1,633 (43.5)	3,266 (43.5)	0.0
CCI score (in a 1-year pre-index period); mean (SD)	2.7 (2.2)	2.2 (1.9)	24.3
Recurrent events of stroke subgroup
Number of myocardial infarction events; n (%)	59 (16.1)	N/A	N/A
Number of stroke events; n (%)	256 (69.8)	N/A	N/A
Number of angina pectoris events; n (%)	52 (14.2)	N/A	N/A
Total number of recurrent CV events; n (%)	367 (100.0)	N/A	N/A
Number of patients with myocardial infarctions; n (%)	55 (1.5)	N/A	N/A
Number of patients with strokes; n (%)	224 (6.0)	N/A	N/A
Number of patients with angina pectoris; n (%)	47 (1.3)	N/A	N/A
Distinct number of patients with recurrent CV event; n (%)	326 (8.7)	N/A	N/A

Abbreviations: CCI, Charlson comorbidity index; CV, cardiovascular; MI, myocardial infarction; SD, standard deviation.

Figure 1. Distribution of patients by LLT intensity prior to the index event.

Abbreviations: LLT, lipid-lowering therapy; MI, myocardial infarction.

Table 3. Summary statistics of the HCRU.

HCRU		Mean	SD	Q1	Median	Q3	p-value^a
Overall cohort
Hospitalizations	Cases	2.1	1.5	1.0	2.0	3.0	<0.001
	Controls	0.4	0.8	0.0	0.0	0.0
Duration of hospitalizations (days)	Cases	10.1	12.3	3.0	7.0	11.0	<0.001
	Controls	8.6	9.4	3.0	6.0	10.0
Outpatient visits	Cases	31.7	22.3	19.0	29.0	41.0	<0.001
	Controls	25.6	18.2	14.0	23.0	34.0
Sick leave	Cases	0.2	1.0	0.0	0.0	0.0	<0.001
	Controls	0.2	0.8	0.0	0.0	0.0
Duration of sick leave (days)	Cases	6.0	32.1	0.0	0.0	0.0	<0.001
	Controls	2.3	15.9	0.0	0.0	0.0
MI subgroup
Hospitalizations	Cases	2.2	1.6	1.0	2.0	3.0	<0.001
	Controls	0.4	0.8	0.0	0.0	0.0
Duration of hospitalizations (days)	Cases	11.6	13.6	4.0	8.0	13.0	<0.001
	Controls	9.0	10.6	3.0	6.0	11.0
Outpatient visits	Cases	30.6	26.1	16.0	28.0	40.0	<0.001
	Controls	23.6	18.9	11.0	21.0	33.0
Sick leave	Cases	0.2	1.0	0.0	0.0	0.0	<0.001
	Controls	0.1	0.7	0.0	0.0	0.0
Duration of sick leave (days)	Cases	8.0	39.2	0.0	0.0	0.0	<0.001
	Controls	2.0	15.1	0.0	0.0	0.0
Stroke subgroup
Hospitalizations	Cases	2.0	1.4	1.0	1.5	3.0	<0.001
	Controls	0.4	0.8	0.0	0.0	0.0
Duration of hospitalizations (days)	Cases	13.5	14.7	6.0	9.0	16.0	<0.001
	Controls	8.8	8.5	3.0	6.0	10.0
Outpatient visits	Cases	28.5	21.4	16.0	26.0	38.0	<0.001
	Controls	24.5	18.6	12.0	22.0	34.0
Sick leave	Cases	0.1	0.5	0.0	0.0	0.0	0.006
	Controls	0.1	0.5	0.0	0.0	0.0
Duration of sick leave (days)	Cases	3.7	28.5	0.0	0.0	0.0	<0.001
	Controls	1.2	12.2	0.0	0.0	0.0

^at-test was used for comparison of the means.

Abbreviations: HCRU, healthcare resource utilization; MI, myocardial infarction; Q1, first quartile; Q3, third quartile; SD, standard deviation.

Table 4. Total healthcare costs in cases and controls for the overall cohort and by subgroups.

Healthcare costs (in €)		Mean	SD	Q1	Median	Q3	p-value^a
Overall cohort	Cases	16,045	19,192	6,222	10,408	18,919	<.001
	Controls	4,147	7,826	918	1,924	4,441
MI subgroup	Cases	20,360	23,681	8,263	13,154	23,781	<.001
	Controls	4,011	9,282	752	1,680	4,101
Stroke subgroup	Cases	18,415	20,124	8,023	12,932	21,031	<.001
	Controls	4,055	6,711	829	1,906	4,545

^at-test was used for comparison of the means.

Abbreviations: MI, myocardial infarction; Q1, first quartile; Q3, third quartile; SD, standard deviation.

Figure 2. Healthcare costs distribution by sectors of the overall cohort and controls.

Abbreviation: MI, myocardial infarction.

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.