Economic losses due to low coverage of lipid-lowering therapy in patients with cardiovascular diseases in the Russian Federation
Aim. To assess the economic burden associated with the absence of lipid-lowering therapy (LLT) in patients with cardiovascular diseases (CVD) and hypercholesterolemia (HCS) in the Russian population in 201 6, including direct costs of the health care system and indirect economic losses due to premature death, absenteeism and disa bility. Material and methods. The calculation includes data from local population-based studies (prevalence of HCS, treatment coverage and efficiency), as well as Russian statistics on CVD for 201 6. Population attributive risk (PAR) was determined, which reflected the incidence of excessive morbidity associated with the lack of HCS therapy in developing CVD for the Russian population, based on LDL cholesterol level. Direct and indirect components of economic burden associated with the absence of LLT have been calculated, as well as the number of deaths with the calculation of "lost years of potential life" lacking to reach the age of 72 years, and losses associated with premature mortality in the economically active age. Indirect costs (economic losses) included non-received gross domestic product (GDP) due to premature mortality and disability in economically active age and loss of earnings due to temporary disability (TD). To estimate the indirect costs, the number of people of the working age with permanent disability in each of the disability groups has been calculated. The indirect costs due to temporary disability were calculated as payments of salary including for days of incapacity for work multiplied by the number of days of TD according the Russian statistics data. Results. The absence of LLT in people with HCS increases the risk of CVD related mortality by one third, death due to cerebrovascular diseases, including stroke, by more than a half. PAR was estimated to be 1 7% for CVD mortality in general, 26% for cerebrovascular diseases. Contribution of HCS and the lack of LLT to morbidity is 29% for ischemic heart disease (IHD), 20% for myocardial infarction. Outpatient calls take the first place among all out-patient care statistics, and those associated with IHD are in the leading position among them. Hospitalization takes the second place. The absence of LLT caused the loss of more than 400,000 years of life in economically active age. The direct costs are determined by expenses for hospitalizations in the presence of IHD. The share of direct costs for hospitalizations is 86%, while in the presence of cerebrovascular diseases it is 76.8%. Payments for disability allowance, which refers to direct non-medical costs, exceed 1 54 million Russian rubles (RUR) for IHD and 104 million RUR for cerebrovascular diseases. The biggest share of economic burden associated with the lack of LLT in individuals with this risk factor is accounted for indirect economic losses: about 507 billion RUR in IHD, of which more than 90 billion RUR are associated with myocardial infarction. The costs associated with cerebrovascular diseases make up over 305 billion RUR, the vast majority of which is due to stroke: over 248 billion RUR. Due to the low LLT coverage in the Russian Federation, the economic burden associated with its absence is over 80% of the calculated HCS related losses in total. Conclusion. Economic burden of the lack of LLT in HCS patients is calculated as 530 billion RUR, which is about 0.6% of GDP in 2016, and the largest part of expenditures is related to IHD. The increased awareness of HCS and its improved control with increasing treatment coverage will make possible to lower cholesterol values at the population level, which will also reduce the economic burden of this risk factor for CVD.