Healthcare Resource Utilization, Costs, Clinical Events, and Treatment Patterns in Extreme High-Risk Patients for Cardiovascular Events Undergoing Lipoprotein Apheresis: A German Claims Data Analysis

Abstract

Aim Insights into treatment patterns, clinical and economic burden of patients undergoing Lipoprotein apheresis (LA). 3 cohorts were characterized: newly treated [Cohort A], experienced [B], matched cohort [C, high CV risk without LA].

Method Clinical burden was assessed by cardiovascular-related hospitalizations and procedures. Economic and clinical outcomes were described over a 12-month baseline period up to 3 years after LA initiation.

Results Absolute LA cases decreased from 1.7 to 1.1 per 100,000 patients. In Cohort A, rate of major cardiovascular hospitalizations decreased, while annual healthcare expenditure increased. Cohort B had significantly higher costs than C.

Conclusion LA may be associated with a reduced frequency of myocardial infarction-related hospitalizations. However, it is expensive. Alternatives are needed to reduce its high economic burden.

Zusammenfassung

Zielsetzung Untersuchung der Behandlungsmuster, sowie klinischen und ökonomischen Belastung bei Patienten mit Lipoprotein-Apherese (LA), anhand dreier Kohorten: neu behandelte Patienten (A), bereits behandelte Patienten (B), gematchte Kohorte (C, ohne LA).

Methodik Die klinische Belastung wurde anhand kardiovaskulär bedingter Krankenhausaufenthalte und Prozeduren bewertet. Ökonomische und klinische Ergebnisse wurden 1 bis 3 Jahre nach Beginn der LA beschrieben.

Ergebnisse LA-Fälle sanken von 1,7 auf 1,1 pro 100.000 Versicherter. In Kohorte A sank die Rate der Krankenhausaufenthalte und die jährlichen Ausgaben stiegen. In Kohorte B waren die Kosten höher als in C.

Schlussfolgerung Die LA kann mit weniger Krankenhausaufenthalten im Zusammenhang mit Myokardinfarkten einhergehen, ist jedoch teuer. Zur Verringerung der hohen ökonomischen Belastung werden Behandlungsalternativen benötigt.

Keywords

lipoprotein apheresis - lipid-lowering therapy - HCRU - cost

Schlüsselwörter

Lipoprotein-Apherese - lipidsenkende Therapien - HCRU - Kosten

Publication History

Received: 12 September 2023

Accepted: 18 December 2023

Article published online:
21 May 2024

• References

• 1 Mach F, Baigent C, Catapano AL. et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188
• 2 Federal Statistical Office. Causes of death (2022). Im Internet: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Todesursachen/_inhalt.html#235880; Stand: 10.05.2023
• 3 Busch MA, Kuhnert R. 12-month prevalence of stroke or chronic stroke symptoms in Germany. J Heal Monit 2017; 2: 70-76
• 4 Busch MA, Kuhnert R. 12-month prevalence of coronary heart disease in Germany. J Heal Monit 2017; 2: 64-96
• 5 Mannsverk J, Wilsgaard T, Mathiesen EB. et al. Trends in Modifiable Risk Factors Are Associated With Declining Incidence of Hospitalized and Nonhospitalized Acute Coronary Heart Disease in a Population. Circulation 2016; 133: 74-81
• 6 Nordestgaard BG, Chapman MJ, Ray K. et al. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J 2010; 31: 2844-2853
• 7 Handhle A, Viljoen A, Wierzbicki AS. Elevated Lipoprotein(a): Background, Current Insights and Future Potential Therapies. Vasc Health Risk Manag 2021; 17: 527-542
• 8 Schettler VJJ, Neumann CL, Peter C. et al. The German Lipoprotein Apheresis Registry (GLAR) - almost 5 years on. Clin Res Cardiol Suppl 2017; 12: 44-49
• 9 Schettler VJJ, Peter C, Zimmermann T. et al. The German Lipoprotein Apheresis Registry (GLAR) – more than 7 years on. Atherosclerosis 2021; 331: e21
• 10 Julius U. Current Role of Lipoprotein Apheresis in the Treatment of High-Risk Patients. J Cardiovasc Dev Dis 2018; 5
• 11 National Association of SHI Physicians. 13620 Additional lump sum medical care for LDL apheresis (2022). Im Internet: https://www.kbv.de/html/13259.php?srt=relevance&stp=fulltext&q=13620&s=Search; Stand: 10.05.2023
• 12 AOK PLUS. AOK PLUS - Die Gesundheitskasse für Sachsen und Thüringen (Januar 2023). Im Internet: https://www.aok.de/pk/magazin/cms/fileadmin/pk/plus/pdf/strukturdaten-langversion-aokplus.pdf; Stand: 29.03.2023
• 13 Bundesministerium für Gesundheit. Gesetzliche Krankenversicherung - Mitglieder, mitversicherte Angehörige und Krankenstand - Monatswerte Januar-Februar 2023 (01.03.2023). Im Internet: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Statistiken/GKV/Mitglieder_Versicherte/KM1_Januar_bis_Februar_2023.pdf; Stand: 10.05.2023
• 14 National Association of SHI Physicians. 13622 Additional lump sum medical care for LDL apheresis (2022). Im Internet: https://www.kbv.de/html/13259.php?srt=relevance&stp=fulltext&q=13622&s=Search; Stand: 10.05.2023
• 15 Federal Institute for Drugs and Medical Devices. Online version of the OPS (2022). Im Internet: https://www.dimdi.de/static/de/klassifikationen/ops/kode-suche/opshtml2022/index.htm Stand: 10.05.2023
• 16 Federal Ministry of Health. Statistics on insured persons, broken down by status, age, place of residence and type of health insurance (16.08.2016). Im Internet: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Statistiken/GKV/Mitglieder_Versicherte/KM6_2016.xls; Stand: 10.05.2023
• 17 Federal Ministry of Health. Statistics on insured persons, broken down by status, age, place of residence and type of health insurance (16.08.2017). Im Internet: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Statistiken/GKV/Mitglieder_Versicherte/KM6_2017.xlsx; Stand: 10.05.2023
• 18 Federal Ministry of Health. Statistics on insured persons, broken down by status, age, place of residence and type of health insurance (20.08.2018). Im Internet: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Statistiken/GKV/Mitglieder_Versicherte/KM6_2018.xlsx; Stand: 10.05.2023
• 19 Federal Ministry of Health. Statistics on insured persons, broken down by status, age, place of residence and type of health insurance (16.08.2019). Im Internet: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Statistiken/GKV/Mitglieder_Versicherte/KM6_2019.xlsx Stand: 10.05.2023
• 20 Scientific Institute of the AOK. Anatomical, therapeutic, chemical classification with daily doses for the German pharmaceutical market (Mai 2020). Im Internet: https://www.wido.de/fileadmin/Dateien/Dokumente/Publikationen_Produkte/Arzneimittel-Klassifikation/ATC_2020/wido_atc_gkv-ai_2020.pdf; Stand: 10.05.2023
• 21 Association of SHI Physicians of Saxony. Agreement on the remuneration of goods and services in the outpatient treatment of aphereses (2005). Im Internet: https://www.kvs-sachsen.de/fileadmin/data/kvs/downloads/vertrag/apherese_vb_05.pdf; Stand: 10.05.2023
• 22 Association of SHI Physicians of Thuringia. KV-specific fee schedule items of Thuringia (15.09.2022). Im Internet: https://www.kv-thueringen.de/fileadmin/media2/Abrechnung/4100/KV-spezifische_GONR/reg_GONR_422_20220915.pdf; Stand: 10.05.2023
• 23 Wang A, Richhariya A, Gandra SR. et al. Systematic Review of Low-Density Lipoprotein Cholesterol Apheresis for the Treatment of Familial Hypercholesterolemia. J Am Heart Assoc 2016; 5: e003294
• 24 National Association of SHI Physicians. Quality Report 2017: Year 2016 (2017). Im Internet: https://www.kbv.de/media/sp/KBV_Qualitaetsbericht_2017.pdf; Stand: 10.05.2023
• 25 National Association of SHI Physicians. Quality Report 2018: Year 2017 (2018). Im Internet: https://www.kbv.de/media/sp/KBV_Qualitaetsbericht_2018.pdf; Stand: 10.05.2023
• 26 National Association of SHI Physicians. Quality Report 2019: Year 2018 (2019). Im Internet: https://www.kbv.de/media/sp/KBV_Qualitaetsbericht_2019.pdf Stand: 10.05.2023
• 27 National Association of SHI Physicians. Quality Report 2020: Year 2019 (2020). Im Internet: https://www.kbv.de/media/sp/KBV_Qualitaetsbericht_2020.pdf; Stand: 10.05.2023
• 28 Weiss N, Julius U. Lipoprotein(a) apheresis in patients with peripheral arterial disease: rationale and clinical results. Clin Res Cardiol Suppl 2019; 14: 39-44
• 29 Doherty DJ, Pottle A, Malietzis G. et al. Vascular access in lipoprotein apheresis: a retrospective analysis from the UK’s largest lipoprotein apheresis centre. J Vasc Access 2018; 19: 52-57
• 30 Kohlman-Trigoboff D. Update: Diagnosis and Management of Peripheral Arterial Disease. J Nurse Pract 2019; 15: 87-95.e81
• 31 Desai U, Kharat A, Hess CN. et al. Healthcare resource utilization and costs of major atherothrombotic vascular events among patients with peripheral artery disease after revascularization. J Med Econ 2021; 24: 402-409
• 32 Scully RE, Arnaoutakis DJ, DeBord Smith A. et al. Estimated annual health care expenditures in individuals with peripheral arterial disease. J Vasc Surg 2018; 67: 558-567
• 33 Ertl J, Parhofer KG, Dippel FW. Lipid apheresis for the treatment of LDL hypercholesterolemia in Germany. CardioVasc 2016; 16: 51-56
• 34 Catapano AL, Graham I, De Backer G. et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37: 2999-3058