Abstract 291: Abstract Title: Assessment of The High risk and unmEt Need in Patients with CAD and Type 2 Diabetes (ATHENA): US Healthcare Resource Use and Cost in a Commercially-Insured Population
Authors: Wittbrodt Eric , Andersson Sundell Karolina , Bhalla Narinder , Hunt Phillip , Mellstrom Carl , Wong Nathan 
Published: April 2019

Background:
THEMIS is a large randomized controlled trial (NCT01991795) comparing the effect of ticagrelor vs placebo (both with background acetylsalicylic acid) for the prevention of major cardiovascular (CV) events in patients with coronary artery disease (CAD) and type 2 diabetes (T2D) with no prior myocardial infarction (MI) or stroke. The current study evaluated healthcare resource utilization (HCRU) and cost in patients similar to those eligible for enrollment in THEMIS (THEMIS-like) and in a broader population (T2D-CAD).

Methods:
This retrospective, observational study included patients,
>
50 years old, with pharmacologically treated T2D and no prior MI or stroke collected from the Optum Research Database including Medicare Advantage Part D coverage between January 1, 2007 and December 31, 2017. Both cohorts were followed until disenrollment or end of the study period. The THEMIS-like cohort included patients with evidence of CAD including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or an angina diagnosis. In addition to CAD as above, the broader T2D-CAD cohort included use of prescription antiplatelet therapy. Selected HCRU (heart failure hospitalizations [hHF], nontraumatic bleeding hospitalizations or ED visits, medication use), annualized costs (all-cause and CV-related total, medical, and pharmacy), and secondary prevention medication (antiplatelets, statins, ACE inhibitors, ARBs, and beta-blockers) persistence were analyzed.

Results:
The T2D-CAD (N=203,916) and THEMIS-like (N=127,125) cohorts accounted for 3.5% and 2.2% of the total T2D population, respectively. Mean
+
SD ages were 68
+
9 vs 67
+
9 years and 57% vs 56% were men, respectively. Mean annual all-cause total costs for the THEMIS-like and T2D-CAD cohorts were $43,332 and $36,254, and pharmacy costs accounted for 15.3% and 19.2% of total cost, respectively. CV-related costs accounted for 38.2% of all-cause costs in the THEMIS-like cohort, and 29.1% in T2D-CAD cohort, respectively. Mean all-cause pharmacy and CV-related pharmacy costs were $6,668 and $497 for the THEMIS-like cohort and $6,985 and $739 for the T2D-CAD cohort, respectively. Medication persistence was between 55% and 61% for all medication classes for both cohorts. At least one hHF was experienced by 13.3% of patients in the THEMIS-like cohort and by 10.3% of patients in the T2D-CAD cohort. Bleeding event rates were 0.35 and 0.38 per 100 person-years in the THEMIS-like and T2D-CAD cohorts, respectively.

Conclusion:
Patients in a US commercially-insured population similar to those enrolled in THEMIS incurred high cost of care, which was largely attributable to CV-related causes. Nearly 1 in 7 THEMIS-like patients experienced hHF, and bleeding incidence was low. These findings identify a unique patient population that may benefit from better preventive measures.