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Original Articles

One-Year Costs in Patients With a History of or at Risk for Atherothrombosis in the United States

Elizabeth M. Mahoney, ScD; Kaijun Wang, MS, PhD; David J. Cohen, MD, MSc; Alan T. Hirsch, MD; Mark J. Alberts, MD; Kim Eagle, MD; Frederique Mosse, PharmD; Joseph D. Jackson, PhD; P. Gabriel Steg, MD; Deepak L. Bhatt, MD on behalf of the REACH Registry Investigators

From the From Saint Luke’s Mid America Heart Institute (E.M.M., K.W., D.J.C.), Kansas City, Mo; Division of Epidemiology and Community Health, University of Minnesota School of Public Health, and Minneapolis Heart Institute Foundation (A.T.H.), Minneapolis, Minn; Northwestern University Medical School (M.J.A.), Chicago, Ill; University of Michigan Medical School (K.E.), Ann Arbor, Mich; Sanofi-Aventis (F.M.), Paris, France; Bristol-Myers Squibb (J.D.J.), Princeton, NJ; AP-HP Hôpital Bichat-Claude Bernard (P.G.S.), Paris, France; and VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass.

Correspondence to Elizabeth M. Mahoney, ScD, Director, Health Economics and Technology Assessment, Mid America Heart Institute of Saint Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111. E-mail emahoney1{at}saint-lukes.org

Received June 30, 2008; accepted July 10, 2008.

Background— Atherothrombosis is the underlying cause of cardiovascular, cerebrovascular, and peripheral arterial disease and is the leading cause of death in the industrialized world. The objectives of the present study are (1) to examine the annual costs associated with vascular events and interventions that require hospitalization, as well as long-term medication use for the management of associated risk factors, in a US population of outpatients with multiple atherothrombotic risk factors or a history of symptomatic disease and (2) to compare costs across patient subgroups defined according to specific arterial bed(s) affected and the number of affected arterial beds.

Methods and Results— The international REduction of Atherothrombosis for Continued Health (REACH) Registry enrolled outpatients 45 years of age who had established coronary artery, cerebrovascular, or peripheral artery disease or 3 atherothrombotic risk factors. Data on risk factors, associated medications, and vascular hospitalizations and interventions were collected. Of the total 68 236-patient REACH cohort, 25 763 were enrolled from US sites. Complete 1-year data were available for 23 974 (93%) of the US patients. Annualized medication costs ranged from $2401 to $3481. Mean annual hospitalization costs per patient were $1344, $2864, $4824, and $8155 for patients with 0 (n=6145), 1 (n=14 353), 2 (n=3106), and 3 (n=370) affected arterial beds at baseline (P<0.0001 for trend). Among patients with 1 affected arterial bed, mean hospitalization costs were $2999, $2010, and $3911 for patients with coronary artery disease (n=11 063), cerebrovascular disease (n=2613), and peripheral arterial disease (n=677), respectively. Annualized medication costs ranged from $2401 to $3481.

Conclusions— These results reveal the high economic burden of atherothrombosis-related clinical events and procedures and the especially high economic burden associated with polyvascular disease.

Key Words: costs • coronary disease • cerebrovascular disorders • peripheral vascular disease • thrombosis

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CLINICAL PERSPECTIVE

The online-only Data Supplement is available with this article at http://circoutcomes.ahajournals.org/cgi/content/full/1/1/38/DC1.

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