Association Between Modifiable Risk Factors and Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease in the United States: 2012–2013 Medical Expenditures Panel Survey

Abstract

BackgroundAtherosclerotic cardiovascular disease (ASCVD) causes most deaths in the United States and accounts for the highest healthcare spending. The association between the modifiable risk factors (MRFs) of ASCVD and pharmaceutical expenditures are largely unknown.Methods and ResultsWe examined the association between MRFs and pharmaceutical expenditures among adults with ASCVD using the 2012 and 2013 Medical Expenditure Panel Survey. A 2‐part model was used while accounting for the survey's complex design to obtain nationally representative results. All costs were adjusted to 2013 US dollars using the gross domestic product deflator. The annual total pharmaceutical expenditure among those with ASCVD was $71.6 billion, 33% of which was for medications for cardiovascular disease and 14% medications for diabetes mellitus. The adjusted relationship between MRFs and pharmaceutical expenditures showed significant marginal increase in average annual pharmaceutical expenditure associated with inadequate physical activity ($519 [95% confidence interval (CI), $12–918; P=0.011]), dyslipidemia ($631 [95% CI, $168–1094; P=0.008]), hypertension: ($1078 [95% CI, $697–1460; P<0.001)], and diabetes mellitus ($2006 [95% CI, $1470–2542]). Compared with those with optimal MRFs (0–1), those with average MRFs (2–3) spent an average of $1184 (95% CI, $805–1564; P<0.001) more on medications, and those with poor MRFs (≥4) spent $2823 (95% CI, $2338–3307; P<0.001) more.ConclusionsWorsening MRFs were proportionally associated with higher annual pharmaceutical expenditures among patients with established ASCVD regardless of non‐ASCVD comorbidity. In‐depth studies of the roles played by other factors in this association can help reduce medication‐related expenditures among ASCVD patients.

Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States

“…Further, using characteristics (age, sex, race/ethnicity, Charlson comorbidity index, history of smoking, hypertension, diabetes, dyslipidemia, liver disease, chronic kidney disease, and cancer, as defined previously 12 ) of the index patient with ASCVD in the family (or the oldest patient in families with >1 member with ASCVD), and the size of the family, number of members with ASCVD, and the US census region of their residence in a survey-specific logistic regression, we calculated risk-adjusted rates of high and catastrophic financial burden during the study. In sensitivity analyses, we additionally accounted for characteristics of members without ASCVD and their contribution to their family's health care expenses.…”

“…This approach has been used in prior studies. 12 Since the financial effects of health care are shared by members of a family, 14,15 we defined families as the unit of assessing financial burden of health care expenses. Family units were defined based on the Current Population Survey of the US Census Bureau, 16 representing groups of people related by birth, marriage, or adoption and residing together.…”

“…Moreover, both our study population with ASCVD and our exposure of cost and family income are based on the approach used by several prior studies. 6,12,19,22 Second, while MEPS includes income from diverse sources, including pension funds and retirement accounts, 44 we do not specifically address access to financial savings or other assets that may help avert the financial consequences of high out-of-pocket health care costs. Third, differences in out-of-pocket expenses across groups may not represent differences in insurance coverage alone and may also be affected by the care they sought.…”

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“…However, individuals with a low short term risk but elevated long term risk may benefit from alternative methods of risk factor management. In addition, the fact that drug therapy is usually prescribed when short term risk is high (>7.5% over 10 years) has led to hypertension, diabetes mellitus, and hyperlipidemia becoming three of the top diagnoses related to direct health expenditures in the U.S. [10]. Long term risk factor control plays a key role in the prevention of CVD and is rarely talked about in the clinical setting which may be problematic because short term risk, while clinically important, often underestimate risk burden in young adults (<50 years) [11].…”

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“…Preliminary findings suggest that implementing the Healthy Heart Score into the clinical setting would be accepted by patients and could help increase patient motivation to make and maintain lifestyle changes. Many existing comprehensive lifestyle interventions have been successful in changing lifestyle behaviour's resulting in weight loss and other health benefits [10]. The challenge is to achieve low cost, sustainable interventions that can educate patients on healthy behaviour's so that every person many fully engage in their own health care and healthy lifestyle maintenance.…”