Abstract 250: Economic Burden of Mortality and Cardiovascular Events among Patients with Acute Coronary Syndromes in a Commercial Health Plan
Authors: Ogden Kristine , Patel Aarti A , Mody Samir H , Veerman Mark , Crivera Concetta , Quock Tiffany P 
Published: July 2021

Introduction:
Despite current advances in treatment, acute coronary syndromes (ACS), continues to result in high morbidity and mortality. Annually, an estimated 1.5 million hospital discharges involve patients with ACS. As such, ACS is associated with a substantial economic burden to the US healthcare system, with current estimates ranging from $75-$150 billion annually in aggregate direct medical costs. Adding anticoagulant to standard of care (SOC) may reduce the number of cardiovascular (CV) events in ACS patients. This study estimates the economic burden of mortality and CV events among ACS patients within a commercial health plan.

Methods:
We developed an Excel-based decision-analytic model to estimate the annual economic burden of mortality and CV events (myocardial infarction (MI), ischemic stroke (IS), stent thrombosis (ST), intracranial hemorrhage (ICH), and major bleeds) in a hypothetical commercial plan with a population of ACS patients who were candidates for rivaroxaban anticoagulation therapy. The baseline ACS population of 6,650 patients was calculated from literature estimates and included 100% on standard of care, and 0% on dual SOC and rivaroxaban anticoagulation therapy. ACS prevalence was adjusted for age and anticoagulation status. Estimates for the two-year rates for mortality and CV events were obtained from the two-year randomized double-blind, placebo-controlled rivaroxaban ATLAS clinical trial. Healthcare costs were drawn from the published literature and adjusted to 2011 USD.

Results:
The baseline model projected a total of 299 deaths from any cause, resulting in an estimated $9.52 million in two-year mortality-related healthcare costs to a commercial health plan. In addition, the baseline model estimated 439 MI, 67 IS, 193 ST, 13 ICH, and 27 major bleeding events that were not associated with CABG, resulting in a total of $41.3 million in two-year healthcare costs to a commercial health plan. All other factors being equal, a 10% increase in the dual SOC and rivaroxaban anticoagulation therapy from the SOC population would reduce the number of mortalities by 11, ST events by 5, and MI events by 3, while the number of ischemic stroke events would remain the same. Conversely, there would be an increase of 1 ICH event and 7 major bleeding events not associated with CABG. Two-year ACS-related mortality and CV event costs to the commercial health plan would be reduced by $48,437 for every 1,000 patients with ACS.

Conclusion:
Our findings suggest that a modest 10% increase in anticoagulant use among patients with ACS would reduce mortality, MI, ST and related healthcare costs by 4%, 0.7%, and 3%, respectively. Addition of anticoagulation therapy potentially reduces the incidence of ACS-related mortality, MI, ST and associated healthcare costs to a commercial health plan, and benefits from anticoagulation use should be balanced against the risk of bleeding.