Articles by Bhakti Arondekar
Total Records ( 2 ) for Bhakti Arondekar
Hospital use and medical care costs up to 5 years after triglyceride lowering among patients with severe hypertriglyceridemia
Gregory A. Nichols , Bhakti Arondekar and Terry A. Jacobson
Severe hypertriglyceridemia is associated with resource-intensive conditions such as cardiovascular disease, diabetes, and pancreatitis. Whether triglyceride (TG) reduction reduces annual medical costs has not been studied.
The objective was to compare medical care costs after changes in triglyceride levels for up to 5 years of follow-up.
Using an observational cohort, we identified 808 individuals who had a baseline TG level ≥500 mg/dL in calendar year 2004 and had a second measure 6 to 24 weeks later. We collected all subsequent inpatient, outpatient, and pharmacy use and medical cost data through 2009. Percentage change from baseline TG level was used to create six categories: decreased ≥60%, 45%-59%, 30%-44%, 15%-29%, 0%-14%, and TG increase. We estimated and compared annualized medical care costs by adjusting for baseline costs, baseline TG, high-density lipoprotein, and low-density lipoprotein cholesterol levels, age, sex, smoking status, body mass index, blood pressure, and presence of comorbidities such as diabetes and cardiovascular disease.
Mean age of the cohort was 55.9 ± 11.7 years and 66% were men. Patients who reduced their TG levels by ≥60% experienced a mean annualized reduction from baseline medical costs of $471, whereas costs increased in all other TG change categories. Between-group differences were most pronounced in the first three years, but none were statistically significant.
This observational study was unable to establish that TG lowering among patients with severe hypertriglyceridemia produced statistically significantly lower hospital use or medical care costs. However, the nonsignificant trends observed suggest that a larger study conducted with controlled TG lowering may be warranted.
Clinical and economic benefits observed when follow-up triglyceride levels are less than 500 mg/dL in patients with severe hypertriglyceridemia
Jennifer B. Christian , Bhakti Arondekar , Erin K. Buysman , Susan L. Johnson , John D. Seeger and Terry A. Jacobson
Increased levels of triglycerides are associated with an increased risk of cardiovascular disease and pancreatitis. In this study we investigated the association between patients with severely increased triglycerides whose follow-up triglyceride levels were <500 mg/dL and reduction of important clinical events and associated health care costs.
By using two large U.S. health care claims databases, we identified an initial cohort of 41,210 patients with severe hypertriglyceridemia between June 2001 and September 2010 who had a follow-up laboratory test result 6 to <24 weeks after the initial severe hypertriglyceridemia laboratory value. Of these, 8493 patients' follow-up triglyceride levels remained elevated (≥500 mg/dL) whereas 32,717 were <500 mg/dL. After their qualifying follow-up triglyceride level, patients' cardiovascular events, diabetes-related events, pancreatitis episodes, kidney disease, and related costs were identified. Adjusted incidence rate ratios with the use of Cox proportional hazards models were developed for each outcome.
Patients whose triglycerides remained ≥500 mg/dL had a greater rate of pancreatitis episodes (hazard ratio [HR]1.79; 95% confidence interval [CI] 1.47−2.18), cardiovascular events (HR1.19; 95% CI 1.10−1.28), diabetes-related events (HR1.42; 95% CI 1.27−1.59), and kidney disease (HR1.13; 95% CI 1.04−1.22) compared with patients whose follow-up triglycerides were <500 mg/dL, after we adjusted for important confounders. Adjusted all-cause total and cardiovascular-related costs were significantly lower in the first 3 years in patients whose follow-up triglyceride levels were <500 mg/dL compared with those whose triglyceride levels remained increased.
When follow-up triglyceride levels were <500 mg/dL, we observed an associated reduction in the risk of clinical events and decrease in health care resource use and costs.