United Health Group Brazil, São Paulo, Brazil.
Brazilian Clinical Research Institute, São Paulo, Brazil.
Glob Heart. 2024 Aug 14;19(1):65. doi: 10.5334/gh.1345. eCollection 2024.
There is limited real-world data of lipid control and healthcare costs among patients with and without Atherosclerotic Cardiovascular Disease (ASCVD) in Latin America.
A retrospective cohort study including patients with LDL-cholesterol (LDL-C) assessment from 2015 to 2017 was performed in a health insurance database. Patient characteristics, comorbidities and laboratory data were collected, and International Classification of Diseases (ICD) codes were used to identify a subcohort of patients with ASCVD (secondary prevention) and assess the proportion of these patients with LDL-C controlled. Lipid control among patients without ASCVD (primary prevention) and healthcare costs in one year in the overall population were also assessed.
From the 17,434 patients selected, 5,208 (29.8%) had ASCVD. The mean age of these patients in secondary prevention was 68.9 (±12.3) years and 47.8% were male patients. LDL-C < 70 mg/dL was identified in 19.1% of the ASCVD population and only 4.1% had an LDL-C < 50 mg/dL. LDL control was worse in women compared to men (13.1% vs. 25.7%; P < 0.01). The average cost in one year was 3,591 American dollars (USD) per patient in primary prevention compared to 8,210 dollars per year for patients in secondary prevention (P < 0.01). While outpatient costs accounted for 59.8% of the total cost in the primary prevention group, the main cost of the secondary prevention population was related to hospital costs (54.1%).
Despite the favorable evidence for intensive cholesterol reduction, the evaluation of large real-world database with more than 17,000 individuals showed that the targets of guideline recommendations have not yet been adequately incorporated into clinical practice. Average annual cost per patient in secondary prevention is more than twice compared to primary prevention. Hospital expenses account for most of the cost in the secondary prevention group, while outpatient costs predominate in primary prevention.
在拉丁美洲，患有和不患有动脉粥样硬化性心血管疾病（ASCVD）的患者的血脂控制和医疗保健成本的真实世界数据有限。
对一个医疗保险数据库中 2015 年至 2017 年进行 LDL-胆固醇（LDL-C）评估的患者进行了回顾性队列研究。收集了患者的特征、合并症和实验室数据，并使用国际疾病分类（ICD）代码来确定 ASCVD 亚组（二级预防）患者，并评估这些患者中 LDL-C 控制的比例。还评估了无 ASCVD（一级预防）患者的血脂控制情况以及总体人群中一年的医疗保健费用。
从 17434 名入选患者中，有 5208 名（29.8%）患有 ASCVD。这些二级预防患者的平均年龄为 68.9（±12.3）岁，47.8%为男性患者。ASCVD 患者中 LDL-C<70mg/dL 的比例为 19.1%，仅有 4.1%的患者 LDL-C<50mg/dL。与男性相比，女性的 LDL-C 控制更差（13.1%比 25.7%；P<0.01）。在一级预防中，每位患者的一年平均费用为 3591 美元，而二级预防中每年每位患者的费用为 8210 美元（P<0.01）。虽然门诊费用占一级预防组总费用的 59.8%，但二级预防人群的主要费用与住院费用有关（54.1%）。
尽管有强化降脂的有利证据，但对 17000 多名以上个体的大型真实世界数据库的评估表明，指南建议的目标尚未充分纳入临床实践。二级预防患者的平均年人均费用是一级预防的两倍多。二级预防组的费用主要来自住院费用，而一级预防中则以门诊费用为主。
