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Background and Objective <p>Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death in the USA. We evaluated lipid-lowering therapy (LLT) and the impact of adherence on healthcare costs among patients with ASCVD.</p> Methods <p>This observational cohort study used payor claims and outpatient laboratory data. Adults with ASCVD diagnosed from 1 October 2015 to 31 December 2019 were observed 12&#xa0;months before, and up to 24&#xa0;months after, first LLT use (index; categorized as any LLT, statin monotherapy, ezetimibe monotherapy, or anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibody [PCSK9 mAb] monotherapy). Treatment patterns, low-density lipoprotein cholesterol (LDL-C) measurements, LLT adherence (proportion of days covered ≥&#xa0;0.80), and healthcare resource utilization and costs were reported.</p> Results <p>Of patients with 12&#xa0;months’ follow-up post-ASCVD diagnosis, 35% did not receive LLT within 12&#xa0;months. Among those receiving any LLT, 95.4% received statin monotherapy at index, 1.6% ezetimibe monotherapy, and 0.3% anti-PCSK9 mAb monotherapy. In the cohort with 12&#xa0;months’ follow-up post-index (<i>N</i>&#xa0;=&#xa0;417,625), the proportion of adherent patients was 66.0% for statin monotherapy, 58.0% for ezetimibe, and 54.9% for anti-PCSK9 mAb users. Among adherent patients, 25.0% of statin, 13.5% of ezetimibe, and 37.7% of anti-PCSK9 mAb users achieved LDL-C &lt;&#xa0;70&#xa0;mg/dL within 12&#xa0;months. ASCVD-related 12-month per patient per month medical costs were higher for nonadherent patients across LLT categories except ezetimibe.</p> Conclusions <p>The high proportion of patients not reaching their LDL-C goal, including those adherent to LLT, demonstrates persistent gaps in care. Adherent patients had lower LDL-C and lower ASCVD-related costs.</p>

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Treatment Patterns and Healthcare-Related Costs in Patients with Atherosclerotic Cardiovascular Disease: Insights from a Large US Healthcare Insurer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月15日

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  • Joseph L. Smith,
  • Laetitia N’Dri,
  • Zhengzheng Jiang,
  • Mukul Singhal,
  • Joaquim Cristino,
  • Batul Dahodwala

摘要

Background and Objective

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death in the USA. We evaluated lipid-lowering therapy (LLT) and the impact of adherence on healthcare costs among patients with ASCVD.

Methods

This observational cohort study used payor claims and outpatient laboratory data. Adults with ASCVD diagnosed from 1 October 2015 to 31 December 2019 were observed 12 months before, and up to 24 months after, first LLT use (index; categorized as any LLT, statin monotherapy, ezetimibe monotherapy, or anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibody [PCSK9 mAb] monotherapy). Treatment patterns, low-density lipoprotein cholesterol (LDL-C) measurements, LLT adherence (proportion of days covered ≥ 0.80), and healthcare resource utilization and costs were reported.

Results

Of patients with 12 months’ follow-up post-ASCVD diagnosis, 35% did not receive LLT within 12 months. Among those receiving any LLT, 95.4% received statin monotherapy at index, 1.6% ezetimibe monotherapy, and 0.3% anti-PCSK9 mAb monotherapy. In the cohort with 12 months’ follow-up post-index (N = 417,625), the proportion of adherent patients was 66.0% for statin monotherapy, 58.0% for ezetimibe, and 54.9% for anti-PCSK9 mAb users. Among adherent patients, 25.0% of statin, 13.5% of ezetimibe, and 37.7% of anti-PCSK9 mAb users achieved LDL-C < 70 mg/dL within 12 months. ASCVD-related 12-month per patient per month medical costs were higher for nonadherent patients across LLT categories except ezetimibe.

Conclusions

The high proportion of patients not reaching their LDL-C goal, including those adherent to LLT, demonstrates persistent gaps in care. Adherent patients had lower LDL-C and lower ASCVD-related costs.