Abstract Body (Do not enter title and authors here): Background: Low-density lipoprotein cholesterol (LDL-C) is an independent risk factor associated with atherosclerotic cardiovascular disease (ASCVD) and related morbidity, mortality, and healthcare costs in the US. Studies demonstrate that evolocumab significantly reduces LDL-C and the risk of CV events. However, there is limited real-world evidence on healthcare resource utilization (HCRU) and cost after evolocumab initiation.
Goal: This study described all-cause HCRU and costs before and after evolocumab initiation in patients with ASCVD.
Methods: This retrospective cohort study used data from Optum Clinformatics™ Data Mart. Adults with a claim for evolocumab from 2019 to 2021, a diagnosis of ASCVD, prior statin use, and a valid LDL-C measurement were included. The index date was the first claim for evolocumab. The baseline period was 12 months, and follow-up was 6 months to 2 years. Medical costs, number of inpatient hospitalizations, and emergency department (ED) visits were assessed as per patient per year. Pharmacy costs and the potential offset of increased pharmacy costs by reductions in medical costs were also explored. Descriptive statistics and the Wilcoxon signed-rank test were used to compare baseline and follow-up measures. Costs were adjusted to $2023 USD.
Results: The study cohort included 2,599 patients who met the selection criteria. The mean (standard deviation [SD]) age was 69 (9.1) years, with the majority being male (56%), Medicare beneficiaries (74%), and residing in the South (56%; Table 1). The mean (SD) baseline LDL-C was 117 (47.7) mg/dL, and the mean (SD) Elixhauser comorbidity index score was 6.4 (8.1). High-intensity statins were used by 56% of patients before evolocumab initiation. The median (interquartile range [IQR]) medical costs declined from $13,600 ($39,693) during baseline to $13,146 ($27,810) in the follow-up (P < 0.001). The mean (SD) inpatient hospitalizations decreased from 0.32 (0.69) to 0.28 (0.70) (P = 0.02), while the mean ED visits remained unchanged (Table 2). Exploratory analysis indicated that a reduction in medical costs offsets the increase in pharmacy costs, resulting in a net decrease in annual total healthcare costs by $65 per patient per year (Table 3).
Conclusion: Among patients with a history of ASCVD initiating evolocumab, medical costs and inpatient hospitalizations decreased after evolocumab initiation, thus, highlighting the benefits of evolocumab use in secondary ASCVD prevention.