(33) Economic burden associated with systemic inflammation in patients with established atherosclerotic cardiovascular disease and stage 3-4 chronic kidney disease

Background: : Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in the United States, affecting over 26 million people. Further, patients with ASCVD and co-existing chronic kidney disease (CKD) have a greater risk of major adverse cardiovascular events (MACE) than patients without CKD. Clinical trials have documented a residual risk of MACE linked to systemic inflammation (SI) after guideline directed medical therapy. However, the economic burden of SI in patients with established ASCVD and stage 3-4 CKD is unclear.

Objective: : To assess the association between SI and economic outcomes in patients with established ASCVD and stage 3-4 CKD.

Methods: : This retrospective study identified patients from the Komodo Healthcare Map (Jan 1, 2016 – Jun 30, 2024) based on diagnosis and procedure codes in medical claims. CKD and its stage were determined from medical claims or laboratory estimated glomerular filtration rate. SI was defined using high-sensitivity C-reactive protein (hsCRP) testing: with SI, ≥1 hsCRP value of 2-10 mg/L; without SI, all hsCRP values < 2 mg/L. HsCRP test results >10 mg/L or conducted during acute illness were excluded. The study endpoints were healthcare resource utilization and costs. Multivariable models were used.

Results: : Among 6,351 patients with ASCVD + stage 3-4 CKD and a qualifying hsCRP, mean age was 71 years, 44% were male, and the average follow-up was 38 months. Of the eligible patients, 3,600 (57%) had SI.
During follow-up, the rates of inpatient admissions per patient per year for those with and without SI were 0.25 and 0.19, respectively, while the rates of outpatient services were 18.2 and 17.0. After adjusting for patient characteristics, SI was associated with a 30% increase (OR 1.30, 95%CI 1.15-1.47) in inpatient admissions and a 5% increase (RR 1.05; 95%CI 1.04-1.05) in outpatient services.
The annual all-cause healthcare costs were $26,089 per patient with SI and $20,753 per patient without SI. Inpatient costs accounted for 34.3% and 29.8% of the total costs, respectively. After adjusting for patient characteristics and baseline costs, SI was associated with a 20% increase in total healthcare costs (RR 1.20, 95%CI 1.11, 1.30). SI was also associated with increased hospitalization costs due to myocardial infarction (RR 1.90; 95%CI 1.27, 2.90) and stroke (RR 2.65; 95%CI 1.71, 4.24).

Conclusions: : SI is strongly associated with overall healthcare resource utilization and costs in patients with ASCVD and stage 3-4 CKD. This study highlights the economic burden related to SI in this population.

Sponsorship:: Novo Nordisk Inc.