Economic burden of elevated lipoprotein(a) in secondary prevention atherosclerotic cardiovascular disease cohort from England

Introduction In the UK, the associated cost of cardiovascular disease (CVD) accounts for £12 billion each year (1). Elevated lipoprotein(a) (Lp(a)) is an independent, genetic and causal driver of increased CVD risk, affecting approximately one in five individuals (2, 3). A previous study conducted in UK Biobank has demonstrated association of elevated Lp(a) levels with increased rate of subsequent major adverse cardiovascular event (4). Purpose To investigate the cardiovascular (CV) economic burden associated with elevated Lp(a) levels in patients with established atherosclerotic cardiovascular disease (ASCVD)*. Methods This observational, retrospective cohort study included adult patients (≥40 years) from the UK Biobank (March 2006 – October 2021) with Lp(a) measurement and first diagnosis of ASCVD* in a secondary care setting. Economic burden was assessed as CV-related hospitalisation admissions and cost in the first 24 months (post index) for patients with <65 nmol/L (≈30 mg/dL) and elevated (≥150 nmol/L≈70 mg/dL) Lp(a). CV related hospitalisations were identified using CV specific episodes from linked Hospital Episode Statistics (HES) database using International Classification of Diseases (ICD) and Office of Population Censuses and Surveys (OPCS) Classification of Interventions and Procedures code. These episodes were mapped to CV related Healthcare Resource Group (HRG) groups and costed using the NHS England reference costs (5,6), taking into account the excess bed days. Results A total of 40,428 patients were included with mean (SD) age of 66.4 (7.95) years, of whom 42.4% were female (Table 1). Among them 14.6% (n=5,915) had elevated Lp(a) levels and 70.3% (n= 28,410) patients had Lp(a) <65 nmol/L. The median (IQR) Lp(a) level was 22.0 (8.0 - 89.4) nmol/L. Mean CV-related hospital care cost was 23% (95% CI: 16.5% - 30.8%) higher in patients with elevated Lp(a) vs. <65 nmol/L Lp(a) (£3,456 vs. £2,792) during the first 24 months of post index time period (Table 2). Significantly higher mean CV-related hospital admissions,13.4% (95% CI: 6.8% - 20.2%) were observed in patients with elevated Lp(a) levels compared to those with Lp(a) <65 nmol/L. Conclusion(s) The findings from this study support that elevated Lp(a) is associated with greater CV cost, imposing burden to healthcare system. Managing patients with elevated Lp(a), especially with Lp(a) targeted therapies, might alleviate the overall economic burden associated with CVD.