Optimal Risk Factor Control Translates Into Less Expenditure on Healthcare, Use of Resources

The optimal control of cardiovascular risk factors in patients with and without CVD is associated with lower healthcare costs and less resource utilization, including fewer visits to the hospital, emergency department, or outpatient clinics, according to the results of a new study.

Take Home: Optimal Risk Factor Control Translates Into Less Expenditure on Healthcare, Use of Resources

Spending on healthcare ranged across the spectrum—those with CVD and poor risk factor control had the highest average per-capita expenditure on healthcare resources and those without CVD and optimal risk factor control spent the least. To TCTMD, senior investigator Khurram Nasir, MD (Baptist Health South Florida, Miami), said the transition from primary prevention to secondary prevention simply adds greater expense and resource use, regardless of risk factor control.

"Even if you have the worst cardiovascular risk factor profile, if you don’t have established CVD, your annual costs and resource utilization [are] still better than somebody who has CVD but has an optimal risk profile,” said Nasir. “At the end of the day, not having CVD is better.” In terms of resource utilization and health spending, “you might be better off having more risk factors and no CVD than somebody with established cardiovascular disease but an optimal risk profile,” he said.

Study investigators, including lead researcher Javier Valero-Elizondo, MD (Baptist Health South Florida), presented the results on March 3 at the American Heart Association (AHA) Epi|Lifestyle 2016 Scientific Sessions in Phoenix, AZ. The study was published concurrently in Circulation: Cardiovascular Quality and Outcomes.

Poor Risk Factor Control in Nearly 18%

The analysis included a sample of 15,651 participants who completed the 2012 Medical Expenditure Panel Survey (MEPS), which is part of a set of large-sce national surveys designed to collect information from individuals and families about the health services used, their frequency, and cost, among other variables.

Individuals were stratified based on control of six risk factors for cardiovascular disease. These risk factors—hypertension, diabetes mellitus, hypercholesterolemia, smoking status, physical activity, and obesity—are part of the AHA “Life’s Simple 7”, a metric used to assess cardiovascular health based on modifiable risk factors. The researchers did not include dietary habits in their analysis as no such data are available from the MEPS database. In the present analysis, participants were categorized as having a poor (≥ 4 cardiovascular risk factors), average (2-3 risk factors), and optimal (0-1 risk factors) profile.

In total, 37.8% of the surveyed individuals had optimal control of cardiovascular risk factors, 44.7% had average, and 17.4% had poor control. Extrapolated to the US population, this translated into approximately 54.2 million, 64.1 million, and 24.9 million people, respectively. In the fully adjusted model, those with CVD and poor control of cardiovascular risk factors had a mean annual expenditure of $14,157 compared with $8,211 for individuals with CVD but optimal risk factor control. Similar trends were observed in participants without CVD, with individuals having poor, average, and optimal risk factor control spending $8,028, $5,469, and $3,998 annually on healthcare.

In terms of the specific charges, the cost of medication was the largest driver of total costs spent on healthcare, followed by hospitalizations, emergency department visits, and outpatient visits. For those with CVD and a poor cardiovascular risk profile, 29.0% reported at least one hospitalization in the past 12 months. In contrast, among those with poor control of cardiovascular risk factors but no overt CVD, just 10.9% reported a hospitalization in the past year. For those who both lacked disease and had optimal risk factor control, only 3.42% were hospitalized in the previous 12 months.

“You can see a huge 10-fold reduced risk of being hospitalized across the spectrum,” said Nasir, referring to the differences among between patients with CVD/poor control and those without CVD/optimal risk factor control. “It definitely highlights the importance of primary prevention,” he added. “That can’t be understated here.”

To TCTMD, Nasir said that the 2010 Affordable Care Act has expanded screening and counseling for modifiable risk factors and these new data support that shift in care. Healthcare systems understand the value of primary prevention, but it has been difficult to put a value on it. “Prevention activities can potentially increase upstream healthcare costs,” he said. “Our study will at least provide them with some concrete numbers, that if they’re able to reduce the burden of CVD risk factors, there are potential opportunities for cost-savings from the healthcare expenditure standpoint.”

James De Lemos (UT Southwestern Medical Center, Dallas, TX), who was not involved in the analysis, said the study supports previously published data showing that better risk factor control has impacts not only clinical outcomes but also long-term costs. Many of these past studies have examined the control of cardiovascular risk factors in midlife and then looked how such control translates into Centers for Medicare & Medicaid costs later in life.

“It meets the common sense test and falls in line with we’d expect,” he said, noting that cardiovascular morbidity and hospitalizations are reduced among people with better risk factor control.

Like Nasir, De Lemos noted there are some upfront costs associated with prevention, including hospital visits and medication, for example, even though the majority of risk factor control is lifestyle oriented. One of the interesting questions is whether the same cost paradigm holds in an era where new diabetes and lipid-lowering medications are much more expensive, he said. Metformin and statins are currently generic, but the new agents, including the PCSK9 inhibitors, are very pricey. “You might extend the clinical benefit but mitigate the cost benefit, because the therapies themselves are so expensive,” said De Lemos.  

Valero-Elizondo J, Salami JA, Ogunmoroti O, et al. Favorable cardiovascular risk profile is associated with lower health care costs and resource utilization. Circ Cardiovasc Qual Outcomes. 2016;Epub ahead of print.

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Michael O’Riordan is the Associate Managing Editor for TCTMD and a Senior Journalist. He completed his undergraduate degrees at Queen’s…

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  • Nasir reports serving on the advisory board of Quest Diagnostics and consulting for Regeneron.
  • Valero-Elizondo and De Lemos reports no conflicts of interest.