Discussion
death, stroke, cancer, coronary and cerebrovascular diseases, cognitive decline, cardiovascular adverse
CVD, STROKE, EVENT, CANCER, ADVERSE EVENTS, DISEASE, SECONDARY, OTHER CARDIOVASCULAR CONDITIONS, EVENTS, HEART FAILURE
In this study, a number of key vascular and nonvascular events experienced by patients with a history of CVD were found to have important and long‐lasting impacts on QoL and hospital costs. These impacts were derived using high‐quality data from a large study with adjudicated event end points and about 4 years of follow‐up. In both UK and US health care system perspectives, patients experiencing stroke, heart failure, noncoronary revascularization, and incident cancer incurred the largest QoL reductions, whereas CRV and noncoronary revascularization procedures were associated with the largest additional hospital costs. Although the QoL reductions associated with adverse events were largely comparable, it was considerably more expensive to receive treatment in the United States.Study data from Europe and North America were used, together with respective UK or US QoL utility weights and unit costs, to assess the impacts of adverse events on QoL and hospital inpatient costs from the UK and US perspectives, respectively. Only about 20% to 40% (United Kingdom) or 30% to 45% (North America) of key disease events occurred among participants recruited in the United Kingdom or North America, respectively, and analyses using these smaller numbers of events produced less precise estimates as indicated by sensitivity analyses. Furthermore, there were no important differences in likelihood of inpatient admission and, following use of the same QoL utility weights and unit costs, nor were there differences in the QoL utility and hospital inpatient costs associated with key disease events between participants recruited in the United Kingdom, North America, and the rest of Europe. We have also reported in sensitivity analyses separate estimates derived using only participants recruited in United Kingdom and only participants recruited in North America, with estimates in line with the main study findings. Moreover, the study assessed the impact of events on all subsequent inpatient hospital costs, cardiovascular and nonvascular, in recognition of the increased risk, not only of recurrent cardiovascular events and other cardiovascular conditions but also of cognitive decline,QoL reduction associated with cardiovascular adverse events in predominantly secondary CVD prevention populations have been previously reported from the perspectives of UKWe report estimates of hospital care costs associated with new cardiovascular events in patients with a history of CVD from both UK and US public health care perspectives. Although the additional costs were highest in the year of event, costs were also increased in subsequent years, and analyses that fail to accurately incorporate these long‐term costs may produce serious underestimates of the health care costs of these events and the savings from averting them. The comparability of estimated costs with previous work is limited by different patient populations and costing methodologies. Nevertheless, a similar ordering of costs by event types have been reported.Our study has a number of limitations. First, we focused on a number of major vascular events targeted in secondary cardiovascular prevention and therefore of interest in policy analyses of new cardiovascular therapies. Second, the study is based on clinical trials data and there may be volunteer bias whereby healthier individuals enrolled in the study. This is a common limitation that needs to be balanced against the high quality of data collected in clinical trials, which can be used for analyses such as these. Nevertheless, efforts to collect sufficiently detailed data in the real world should be made. Third, study participants who died (1668 [7.6%]) or did not provide a QoL measure at the end of the study (831 [3.8%]) did not contribute to the QoL modeling so there may be bias. In applications, QoL is used concurrently with survival in assessing the net effects of treatments and our analysis is in line with how these estimates are intended for use. This does make the assumption that the estimated QoL reductions apply up to the time before death in those participants who died. This may not be true if, for example, participants who survived have experienced better recovery from adverse events and thus may have better QoL than participants who experienced an event and later died before QoL measurement. Fourth, hospital costs included in the present study likely underestimate the total hospital care cost for 2 reasons. No data were available in the study about patients' use of hospital outpatient services and therefore these costs were not included. Furthermore, US Medicare and UK National Health Service costs were used, which are lower than private health care costs. Therefore, the costs presented reflect only the respective country's public health care admissions and costs. Finally, we also did not assess the primary and ambulatory care costs associated with adverse events. Previous CVD burden studies have indicated that the inpatient hospital care costs account for the majority of health care costs of coronary and cerebrovascular diseases (57% and 79%, respectively in 2015, United KingdomDespite these limitations, our study benefits from high‐quality detailed data of a large trial cohort that allowed us to report that the occurrence of key vascular and nonvascular events in patients with well‐managed CVD continues to affect significantly individuals' QoL and hospital care resources.