Work productivity loss and indirect costs associated with new cardiovascular events in high-risk patients with hyperlipidemia: estimates from population-based register data in Sweden.
Work productivity loss and indirect costs associated with new cardiovascular events in high-risk patients with hyperlipidemia: estimates from population-based register data in Sweden.
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DOI：
10.1007/s10198-015-0749-y
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发表时间：
2016-12
影响因子：
4.4
通讯作者：
Gandra, S. R.
中科院分区：
文献类型：
--
作者：
Banefelt, J.;Hallberg, S.;Fox, K. M.;Mesterton, J.;Paoli, C. J.;Johansson, G.;Levin, L-A.;Sobocki, P.;Gandra, S. R.
评估发生心血管（CV）事件的高风险高脂血症患者的生产力损失和相关间接成本。回顾性基于人群的队列研究，使用与国家登记相关的瑞典医疗记录进行。根据2006年1月1日至2011年12月31日期间的降脂治疗处方纳入患者，并随访至2012年12月31日，以确定CV事件并估计工作生产力损失（病假和残疾抚恤金）和间接成本。根据CV风险水平将患者分层为两个队列：重大心血管疾病（CVD）史和冠心病（CHD）等效风险。应用倾向评分匹配来比较有新事件的患者（病例）与无新事件的患者（对照）。CV事件的增量效应使用差异中差异设计进行估计，比较病例和对照组在病例事件前一年和后一年的生产力损失。CHD风险等效队列（n = 2946）对间接成本的增量效应最大，为3119欧元（P值<0.01）。主要CVD病史队列（n = 4508）的相应数字为2210欧元（P值<0.01）。根据事件类型，生产力损失有很大差异。短暂性脑缺血发作和血运重建对间接成本无显著影响。心肌梗死（3465欧元）、不稳定型心绞痛（2733欧元）和最显著的缺血性卒中（6784欧元）产生了显著的增量成本估计（P值<0.01）。在接受高脂血症治疗的瑞典高危患者中，与CV事件的工作生产力损失相关的间接成本很大，并且根据事件类型差异很大。
To estimate productivity loss and associated indirect costs in high-risk patients treated for hyperlipidemia who experience cardiovascular (CV) events. Retrospective population-based cohort study conducted using Swedish medical records linked to national registers. Patients were included based on prescriptions of lipid-lowering therapy between 1 January 2006 and 31 December 2011 and followed until 31 December 2012 for identification of CV events and estimation of work productivity loss (sick leave and disability pension) and indirect costs. Patients were stratified into two cohorts based on CV risk level: history of major cardiovascular disease (CVD) and coronary heart disease (CHD) risk equivalent. Propensity score matching was applied to compare patients with new events (cases) to patients without new events (controls). The incremental effect of CV events was estimated using a difference-in-differences design, comparing productivity loss among cases and controls during the year before and the year after the cases’ event. The incremental effect on indirect costs was largest in the CHD risk equivalent cohort (n = 2946) at €3119 (P value <0.01). The corresponding figure in the major CVD history cohort (n = 4508) was €2210 (P value <0.01). There was substantial variation in productivity loss depending on the type of event. Transient ischemic attack and revascularization had no significant effect on indirect costs. Myocardial infarction (€3465), unstable angina (€2733) and, most notably, ischemic stroke (€6784) yielded substantial incremental cost estimates (P values <0.01). Indirect costs related to work productivity losses of CV events are substantial in Swedish high-risk patients treated for hyperlipidemia and vary considerably by type of event.
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