Abstract 144: Cost of Cardiovascular Disease Episodes among Patients with Hypertension

Background: Because of its high prevalence and direct contribution to cardiovascular diseases (CVD), hypertension is among the most expensive components of CVD, representing nearly 50% of the total direct medical cost of CVD in the U.S. Yet, little is known about the per-patient cost of CVD episodes among hypertensives. Methods: This study used insurance claims data from over 16,000 individuals diagnosed with hypertension and enrolled in a private health insurance plan between 2008 and 2010. About one million medical and pharmacy insurance claims generated by these hypertensive patients were extracted for the analysis. Six CVD were included in the study: Myocardial infarction (MI), unstable angina (UA), stable angina (SA), transient ischemic attack (TIA), stroke, and congestive heart failure (CHF). Direct medical costs (ambulatory, emergency, hospital visits and medications) for each CVD were obtained on a weekly basis over 26 weeks before and after a recorded CVD episode. Per-patient direct medical costs were estimated by taking a before-after difference in cost, corrected by censoring due to deaths and insurance plan exits. Average costs were segmented by age groups (40-64 and 65 or over). Costs were adjusted to 2010 U.S. dollars. Results: The most expensive CVD episode among hypertensives was UA ($17,704; 95%CI $11,632-22,644), followed by MI ($13,480; 95%CI $8,328-18,752), stroke ($13,223; 95%CI $8,080-17,556), CHF ($12,462; 95%CI $9,734-15,335), SA ($6,991; 95%CI $4,178-9,947), and TIA ($5,787; 95%CI $2,671-9,670). CVD costs converged to pre-event cost levels within the next 4 to 14 months after the recorded CVD episode. Some CVD costs (CHF, UA, MI) rose 1 to 3 weeks before the recorded event, while others (stroke, TIA, SA) clearly started during the week of the recorded event (see Figure 1 comparing CHF and stroke). For the former, pre-event costs explained up to 30% of total costs. Conclusions: Cost estimates of CVD episodes among hypertensive patients are consistent with results from the scarce literature in this area. Moreover, our study finds evidence of increased medical resource utilization weeks before the recording of the CVD episode. Omitting these pre-event costs leads to an underestimate of the true costs of CVD. ![][1] [1]: /embed/graphic-1.gif