A Decade of Cardiovascular Disease Costs in Genetically Confirmed Familial Hypercholesterolaemia

Overview

This study analyzed cardiovascular disease (CVD)-related hospital and pharmaceutical costs over 10 years in 5585 genetically confirmed familial hypercholesterolaemia (FH) patients compared to 111,483 matched controls. FH patients incurred nearly threefold higher hospital costs and over tenfold higher pharmaceutical costs, with drug expenses rising significantly due to new therapies.

Background

Familial hypercholesterolaemia (FH) is a genetic disorder causing elevated LDL-cholesterol from birth, leading to increased risk of premature cardiovascular disease such as myocardial infarction and ischemic heart disease. The prevalence of FH is approximately 1 in 313 individuals. Treatment involves lifestyle modification and lipid-lowering medications to reduce atherosclerosis risk. Norway’s comprehensive health registries and tax-funded healthcare system allow for near-complete capture of hospital and pharmaceutical resource use in FH patients. Understanding the economic burden of FH-associated CVD is important for clinical management and healthcare policy.

Data Highlights

Key Findings

• FH patients had approximately three times higher CVD-related hospital costs (€3911 vs €1498) over 10 years compared to controls.
• Pharmaceutical costs related to CVD were more than tenfold higher in FH patients (€6119 vs €514), driven largely by newer lipid-lowering drugs.
• Costs for percutaneous coronary interventions were four times higher in FH patients (€561 vs €140).
• Pharmaceutical costs increased significantly over the decade in both FH and control groups (P=0.002 and P=0.005, respectively), mainly due to introduction of PCSK9 inhibitors.
• Hospital care costs decreased over the study period in FH patients (P=0.0069) and showed a non-significant decrease in controls (P=0.0943).

Clinical Implications

Clinicians should be aware that FH patients represent a high-cost group for cardiovascular care, particularly regarding pharmaceutical treatment. The rising drug costs reflect adoption of advanced therapies such as PCSK9 inhibitors, emphasizing the need for cost-effective management strategies. Early diagnosis and optimized treatment may help reduce hospitalizations and associated costs over time.

Conclusion

Genetically confirmed FH patients incur substantially higher cardiovascular-related hospital and pharmaceutical costs than matched controls over a decade. While pharmaceutical expenses have risen, hospital costs have declined, highlighting evolving patterns of care in this high-risk population.

References

1. Authors/Unit for Cardiac and Cardiovascular Genetics/2024 -- A Decade of Cardiovascular Disease Expenses in Genetically Confirmed Familial Hypercholesterolaemia Compared to Age- and Sex-Matched Controls