Economic burden of atherosclerotic cardiovascular disease: costs related to healthcare and loss of productivity; a matched case-control study in more than 450,000 Swedish individuals
Authors: Carlsson K , Nilsson K , Wolden M L , Faurby M 
Published: October 2022

Abstract

Introduction
Atherosclerotic cardiovascular disease (ASCVD) is associated with significant morbidity and mortality. We aimed to quantify the impact of ASCVD on healthcare costs, risk of cardiovascular (CV) events and mortality.

Purpose
To examine the progression of direct healthcare costs, indirect costs and other outcomes over 5 years in people with ASCVD and matched controls in Sweden.

Methods
In this 5-year retrospective closed cohort study, adults (aged ≥18 years) living in Sweden on 1/1/2012 were identified in an existing database,1,2 and those with ASCVD (≥1 inpatient admission/outpatient visit with a main or sub-diagnosis relating to stroke, ischaemic heart disease or peripheral artery disease, or procedure codes related to revascularization or amputation, in the National Patient Register [1997–2011]) were propensity score matched to controls without ASCVD by birth year, sex and educational status. Study variables included costs of selected hospital-based care and prescription drugs, and mortality from the National Board of Health and Welfare; demographic and socioeconomic information from Statistics Sweden; and work absences from Försäkringskassan (Swedish Social Insurance Agency). We compared annual direct healthcare costs (inpatient, outpatient and drug costs) and indirect costs from lost productivity, and analysed risks of early retirement, stroke, myocardial infarction and mortality. Hazard ratios (HRs) were estimated using Cox proportional regression adjusted for baseline age, sex, comorbidities, education and marital status.

Results
Individuals with ASCVD (N=231,417) had similar ages, sex distribution and education to matched controls, but were more likely to have T2D or renal disease (Table). Over the 5-year study period, average annual total direct and indirect costs for people with ASCVD were 2.5 times higher than in controls; direct healthcare costs in the ASCVD group were three times those for controls (Figure). In both groups, indirect costs accounted for nearly two-thirds of total costs. In the ASCVD group, inpatient costs comprised 74% of total direct costs, whereas outpatient costs and drug costs contributed 15% and 11%. In controls, total direct costs were made up of 70% inpatient costs, 18% outpatient costs and 12% drug costs. All-cause mortality was 72% higher in people with ASCVD than in controls (HR: 1.72 [95% confidence interval: 1.69–1.75]). Individuals with ASCVD were also more likely than controls to experience stroke (HR: 1.89 [1.83–1.95]), myocardial infarction (HR: 2.33 [2.26–2.41]) and early retirement (HR: 3.04 [2.78–3.33]).

Conclusions
Individuals with ASCVD incurred more than 2.5 times the total costs of matched controls, and had a greater risk of death, CV events and early retirement. Effective measures to prevent ASCVD and to slow its progression could limit these substantial burdens for individuals, healthcare systems and society.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was supported by a grant from Novo Nordisk A/S to the Swedish Institute for Health Economics. Medical writing support was provided by Oxford PharmaGenesis, Oxford, UK, with funding from Novo Nordisk A/S.