PCV63 - ECONOMIC BURDEN ASSOCIATED WITH SECONDARY CARDIOVASCULAR (CV) EVENTS – A SYSTEMATIC LITERATURE REVIEW

Abstract

Significant burden incurred during first CV event occurrence has been widely observed. This review aimed to identify economic burden associated with subsequent CV events in patients with a prior myocardial infarction (MI) or broader cardiovascular diseases. A systematic search was undertaken in Embase®, MEDLINE® and the Cochrane library to identify relevant English publications of last 10 years (2008–2017). Studies providing data on cost and resource use associated with secondary CV events (MI/revascularisation/stroke/unstable angina [UA]) were included. Sixteen studies (20 publications) met the inclusion criteria. Of these, 12 studies were conducted in US, two in Asia and one each in UK and Sweden. Data sources for studies included claims database (N=13), national registers, data warehouse and survey (one each). Overall, patients were aged 53.5-75.3 years and the proportion of females varied from 15.8%-54.0%. Higher cost and resource utilization were observed with secondary events compared to the first event (%increase in costs [UK] for MI, UA and stroke – 1-6 months: 9%, 25%, 28%; 7-36 months: 65%, 37%, 14%). However, the US study suggested that the sequence of the event had little bearing on the overall cost. Coronary Artery Bypass Graft was associated with higher costs among all secondary CV events, followed by MI. Across all the events, direct costs and associated resource utilization were higher during the first year compared to subsequent years. CV-related costs generally decrease after the acute period, however, two studies observed that costs remained higher than pre-CV event costs for a longer duration (3 years). Length of hospital stay (LOS) was observed as the major cost driver and presence of diabetes the important predictor for higher costs. Secondary CV events pose a significant burden on patients with history of CVD, mainly due to longer LOS. Additional evidence in patients with a prior MI is required.