Considering Cost Effectiveness in Cardiovascular Risk Reduction - Episode 1

Economic Burden of Cardiovascular Disease

Deepak L. Bhatt, MD, MPH: Hello, and welcome to this AJMC® program titled, “Considering Cost Effectiveness in Cardiovascular Risk Reduction.”

I am Dr Deepak Bhatt, from Brigham and Women’s Hospital and Harvard Medical School. Joining me today in this virtual discussion are my colleagues: Dr Adam Bress, from University of Utah School of Medicine; Dr Matthew Budoff, from the David Geffen School of Medicine at UCLA [University of California, Los Angeles]; Dr Eric Cannon, from SelectHealth; and Dr Ann Marie Navar, from Duke Clinical Research Institute.

Today, our panel of experts will review opportunities for reducing residual cardiovascular risk in patients at high risk for cardiovascular events. They will also focus on the role of cost-effectiveness in therapy evaluation. Let’s go ahead and begin.

First let’s talk a little about determining cardiovascular risk, the burden of cardiovascular disease, risk stratifying patients with cardiovascular disease, the role of dyslipidemia, and in particular, the role of LDL [low-density lipoprotein] cholesterol and triglycerides on cardiovascular risk. And of course, the patient perspective is the most important. But let’s start off here with a discussion for the payer perspective. Cardiovascular diseases are, of course, one of the most, if not the most, costly health care expenses I’d say among chronic diseases in the US, but even to a greater extent, worldwide. What exactly is the reason for that? What’s driving these costs? And what can we do to reduce not just cardiovascular disease but the associated health economic consequences? And to start us off, let me turn to Dr Cannon. What are your thoughts on that?

Eric Cannon, PharmD, FAMCP: I think if we were to look at cardiovascular disease, if we were to look at the cost associated with that, we know that is one of the most significant drivers of cost that we face as a health plan. And if we look at the social responsibility that I think we believe we have in the community, it becomes imperative that we take care of that. And so, knowing that hospitalizations associated with cardiovascular disease are going to drive significant costs is important. Knowing that part of that cost is driven by readmissions, we are working very diligently to not only focus on the existing patients we know about—and I think managing risk factors for patients you know about is one thing—but then taking that more globally out into the community is important. And, how do we reduce the overall risk in the community?

And so, focusing on things such as obesity, diabetes. You mentioned LDL cholesterol levels, triglycerides. How do we appropriately screen patients, find patients, implement effective lifestyle changes, knowing that this is the single biggest driver of our cost? It becomes a very meaningful intervention. I think more than that, if we look at what drives economic burden for our patients, there’s been some research published recently that looked at the economic burden on patients. And knowing that the more we reduce those risk factors, the better the health of our patients. But moreover, the better the health and economics of our community.

Deepak L. Bhatt, MD, MPH: Yes. I like how you brought in the social responsibility aspect of it. I think you’re right. Third-party payers do need to think about that aspect of social responsibility. It’s the right thing to do on a moral level. It’s also, I think, good for business. If one is concerned about health care cost, investing in prevention can do, I believe, a lot to prevent downstream health care costs. And of course from a patient’s perspective, it’s the right thing to do. I’m also glad that you mentioned community health, because a lot of these issues can be addressed quite often with that approach.