Abstract P069: Modifiable Risk Factors as Drivers of Pharmaceutical Expenditures Among US Adults with Atherosclerotic Heart Disease: 2012 Medical Expenditure Panel Survey

Abstract

Background: Atherosclerotic Cardiovascular disease (ASCVD) remains the leading cause of deaths and costs in the US. Despite advancements in therapies, no study has evaluated drivers of pharmaceutical expenditures among individuals with ASCVD. We aimed to assess the economic impact of modifiable risk factors (MRF) on overall pharmaceutical expenditures among ASCVD patients. Methods: We studied the 2012 Medical Expenditure Panel Survey (MEPS) data of adults aged ≥40 years with Body Mass Index ≥18.5Kg/m2 and ICD-9 diagnosis of ASCVD (410, 413, 414, 433, 434, 435, 436, 437, 440, 443, and 447). Using total pharmacy expenditure variable in MEPS as our primary outcome, marginal and actual expenditures associated with predictors were estimated using a two-part econometric model with probit and glm, family(gamma) link (log). Results: Based on the 2012 MEPS, an estimated 140.7 million people in US are aged ≥40 years. An estimated 15.4 million had ASCVD (69±15 years; 41% female). Overall, total pharmaceutical expenditure among those with ASCVD was $52.7 billion (95% CI: $44.2-62.0 billion), which accounted for 33.7% of total pharmaceutical expenditures. Individuals with ASCVD had $1,847 (95% CI: $1,655 - 2,038) incremental pharmaceutical expenditure vs. those without it (p<0.001). The two-part econometric model showed that all MRF independently impacted incremental expenditure. By aggregates of MRF, 50% had 2-3; 39% had 4-6; and the rest (11%) had one or none. The estimated pharmaceutical expenditures was lower with favorable MRF status irrespective of comorbid conditions. In adjusted analyses, as compared to those with ≥4 MRF, those with 2-3 had $1,881 (95% CI: $1,242 -2,521) and those with 0-1 MRF had $2,669 (95% CI: $2,317 - 3,020) lower pharmaceutical costs, respectively. Conclusion: Our study results suggest attainment of favorable modifiable risk status as delineated in AHA 2020 Impact goals can have a beneficial impact on pharmaceutical costs, which accounts for significant proportion of overall healthcare expenditure.