Gavina Cristina, Borges Alexandra, Afonso-Silva Marta, Fortuna Inês, Canelas-Pais Mariana, Amaral Rita, Costa Inês, Seabra Daniel, Araújo Francisco, Taveira-Gomes Tiago
Cardiology Department, Hospital Pedro Hispano-Unidad Local de Saúde Matosinhos, Matosinhos, Portugal.
Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
Health Econ Rev. 2024 Sep 12;14(1):73. doi: 10.1186/s13561-024-00550-2.
Atherosclerotic Cardiovascular Disease (ASCVD) is a global public health concern. This study aimed to estimate the healthcare resource utilization (HRU) and costs stratified by cardiovascular disease (CVD) risk categories using real-world evidence, in a regional population in Portugal.
This is a retrospective observational study, using data from Electronic Health Records between 2017 and 2021. Patients aged ≥ 40 years, and with at least one general practitioner (GP) appointment in the 3 years before 31st of December 2019, were included. CVD risk categories were determined based on 2021 ESC prevention guidelines. HRU encompassed hospital data (hospitalizations, outpatient and emergency room visits) and GP appointments. Total direct costs per patient were calculated based on the reference cost of the Portuguese legislation for payment methodology on Diagnosis-Related Groups (DRGs).
Analysis of 3 122 695 episodes, revealed consistent HRU and costs across the five years. Very high-risk patients, showed higher HRU, particularly in hospital admissions. Costs tended to rise with higher CVD risk level. Very high-risk patients with ASCVD had higher costs for hospital admissions, while low-to-moderate risk patients had higher costs for GP visits. Despite a smaller proportion, very high-risk patients with prior ASCVD represent the highest costs per patient across healthcare settings (from 115€ in emergency visits to 2 673€ in hospitalizations), followed by very high-risk patients without prior ASCVD (ASCVD-risk equivalents).
This study revealed a substantial HRU and costs by patients with very high CVD risk, particularly those with prior ASCVD. Moreover, ASCVD-risk equivalents emerge as notable consumers, emphasizing the importance of risk assessment and preventive measures in cost-effective management of these patients.
动脉粥样硬化性心血管疾病（ASCVD）是一个全球公共卫生问题。本研究旨在利用真实世界证据，估计葡萄牙某地区人群中按心血管疾病（CVD）风险类别分层的医疗资源利用（HRU）和成本。
这是一项回顾性观察研究，使用了2017年至2021年电子健康记录中的数据。纳入年龄≥40岁且在2019年12月31日前3年内至少有一次全科医生（GP）预约的患者。CVD风险类别根据2021年欧洲心脏病学会（ESC）预防指南确定。HRU包括医院数据（住院、门诊和急诊就诊）以及GP预约。根据葡萄牙立法中关于诊断相关分组（DRGs）支付方法的参考成本，计算每位患者的总直接成本。
对3122695例病例的分析显示，五年间HRU和成本具有一致性。极高风险患者的HRU更高，尤其是在住院方面。成本往往随着CVD风险水平的升高而增加。患有ASCVD的极高风险患者住院成本更高，而低至中度风险患者的GP就诊成本更高。尽管比例较小，但既往有ASCVD的极高风险患者在所有医疗环境中每位患者的成本最高（从急诊就诊的115欧元到住院的2673欧元），其次是无既往ASCVD的极高风险患者（ASCVD风险等同者）。
本研究显示，CVD极高风险患者，尤其是既往有ASCVD的患者，医疗资源利用和成本很高。此外，ASCVD风险等同者也是显著的消费者，这强调了风险评估和预防措施在这些患者成本效益管理中的重要性。
