1Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 2Charité - Universitätsmedizin Berlin CC 11: Med. Klinik für Kardiologie Berlin, Deutschland; 3Herz- und Gefäßpraxis Gera, Internistisch-kardiologische Gemeinschaftspraxis Gera, Deutschland; 4SYNLAB Holding Deutschland GmbH SYNLAB Akademie Mannheim, Deutschland
Background
Jena auf Ziel – “JaZ” is a prospective cohort study in which early combination therapy with atorvastatin 80mg and ezetimibe 10mg was initiated on admission in all patients with ST – elevation myocardial infarction (STEMI). Lipid – lowering therapy (LLT) was escalated during follow – up with bempedoic (BA) acid and PCSK9 – inhibitors (PCSK9 – I) if serum LDL – C was not within the ESC / EAS goal of 1.4mmol/L or less. During follow – up 12 months after the index event in our outpatient lipid clinic LDL – C targets were attained in all patients.
Methods and objectives
We collected economic and clinical data, including in – hospital costs and length of stay. Costs related to LLT were derived from a pharmaceutical directory for Germany (Gelbe Liste Pharmindex, Medizinische Medien Informations GmbH (Langen, Germany)). Follow – ups were conducted either by the outpatient lipid clinic through scheduled appointments or through routine standard care provided by general physicians (GPs), according to the patients' preferences. In this secondary analysis of “JaZ” we analyzed cost – effectiveness of intensive LLT therapy compared to a less effective LLT approach within the first 24 months after the index event.
Results
A total of 85 (73 men (85.9%), 12 women (14.1%), age: 64.4 ± 13.1 years) consecutive patients were included in this study. Mean length of the index hospital stay was 7.37 ± 5.27 days. Overall, 631 hospital days accumulated for these 85 STEMI – patients including time spend in high – care monitoring units with average total costs of 9549.82 ± 5670.8 EUR per patient. Total cumulative costs of these stays were 802.185,13 EUR (Figure 1). 24 months after discharge, 96.3% of the patients were on statins (atorvastatin: 67.9%; rosuvastatin: 25.9%), 87.7% on ezetimibe, 17.3% on BA and 6.2% on PCSK9 – I with intermittent adjustments by the two outpatient clinics. Mean LDL – C serum concentrations at baseline and after two years were 3.2 ± 1.2 mmol/L and 1.38 ± 0.69 mmol/L respectively, reflecting a mean LDL – C reduction of 1.78 ± 1.42 mmol/L. During the 24 months of follow – up, the total costs for LLT amounted to: 35.495,78 EUR (average per case: 417,59 ± 100,49 EUR) for statins and ezetimibe; 19.983,87 EUR (average per case: 1.492,09 ± 480,97 EUR) for BA and 59.308,32 EUR (average per case: 11.861,66 ± 1.535,62 EUR) for PCSK9 – I (Figure 1). Four patients died due to non – cardiac causes. MACE occurred in 10 patients (12.3%) that required a second hospital treatment and generated additional costs of 73.411,17 EUR (Figure 1). Patients experiencing MACE during follow – up exhibited a shorter duration within the target LDL – C range compared to those without MACE (58.1 ± 29.9% vs. 79.1 ± 28.1%; p < 0.05) (Figure 2). Additionally, their LDL – C levels after 24 – months were higher (2.04 ± 1.26 mmol/L vs. 1.27 ± 0.47 mmol/L; p < 0.001) (Figure 2). Patients with MACE had lower associated costs for LLT compared to patients without MACE (547.04 ± 475.93 EUR vs. 2.562,29 ± 3.170,20 EUR; p < 0.05). Incorporating the additional costs associated with MACE for the subsequent hospital stay, the overall costs for a more expensive LLT however proved to be less and thus highly cost – effective (2.562,29 ± 3.170,20 EUR vs. 7.921,25 ± 4.140,53 EUR; p < 0.01) (Figure 2).
Conclusion
Intensive lipid – lowering therapy within the first 24 months after STEMI is highly cost effective compared to less effective lipid – lowering approach.