Abstract
Hypercholesterolemia is a clinically relevant condition with an ascertained role in atherogenesis. In particular, its presence directly correlates to the risk of atherosclerotic cardiovascular disease (ASCVD). As known, cardiovascular diseases pose a significant economic burden worldwide; however, a clear picture of the economic impact of ASCVD secondary to hypercholesterolemia is lacking. This study aiming at conducting a systematic review of the current literature to assess the economic impact of familial hypercholesterolemia (FH), non-familial hypercholesterolemia (non-FH) or mixed dyslipidemia. A literature search was performed in Medline/PubMed and Embase database up to September 1st, 2020, exploring evidence published from 2010. The literature review was conducted in accordance with PRISMA guidelines. To be included the studies must be conducted on people who have been diagnosed with familial hypercholesterolemia, non-familial hypercholesterolemia or mixed dyslipidemia, and report data/information on costs attributable to these conditions and their sequelae. A total of 1260 studies were retrieved. After reading the titles and abstract, 103 studies were selected for full reading and eight met the criteria for inclusion. All but one studies were published in the American continent, with the majority conducted in US. An observational design with a prevalence approach were used and all estimated the economic burden of CVD. Direct cost estimates as annual average health expenditure on all population, ranging from $17 to $259 million. Few studies assessing the economic impact of hypercholesterolemia are available in the literature and new researches are needed to provide a more updated and reliable picture. Despite this scarceness of evidence, this review adds important data for future discussion on the knowledge of the economic impact of hypercholesterolemia and costs of care associated to this condition, with important implication for public health researches and novel therapies implementation.
Highlights
Hypercholesterolemia is defined as the presence of high level of plasmatic low-density lipoprotein–cholesterol (LDL-C), with a clinically significant role in the developing of atherogenesis, and being directly correlated to the risk of atherosclerotic cardiovascular disease (ASCVD) [1]
Health expenditure attributable to ASCVD has been the subject of some national research, but a clear picture of the studies on the economic impact of ASCVD secondary to hypercholesterolemia and mixed dyslipidemia is lacking, with available studies conducted at country level with small patient groups or focusing on specific economic aspects associated to the condition [4,5,6]
For the purpose of this study, hypercholesterolemia was intended as the rise in levels of plasmatic LDL-C; familial hypercholesterolemia as inherited autosomal dominant genetic lipid disorder that causes of hypercholesterolemia; mixed dyslipidemia as a condition where hypercholesterolemia is associated with high TG and low high-density lipoprotein–cholesterol (HDL-C) levels [1,2]
Summary
Hypercholesterolemia is defined as the presence of high level of plasmatic low-density lipoprotein–cholesterol (LDL-C), with a clinically significant role in the developing of atherogenesis, and being directly correlated to the risk of atherosclerotic cardiovascular disease (ASCVD) [1]. Cardiovascular diseases (CVD) are estimated to cost more than $863 billion worldwide, posing a significant economic burden that is expected to reach $1,044 billion in 2030 [3]. In this context, the increasing prevalence of hypercholesterolemia and dyslipidemia leads to a massive cost allocation for the healthcare systems in industrialized countries over the years [3]. Costs items contributing to this financial impact are associated to the management of the health consequences and disease-related events, such as ASCVD, and to cost-minimizing (compared with proved equivalent therapeutics) preventive interventions (e.g., screening and pharmacological treatments), which are both are associated to significant healthcare resources consumptions (e.g. hospitalization, diagnostic procedures and revascularization, medical follow-up, and chronic use of several medications) [4,5].
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