This contract research report was commissioned and funded by MSD. MSD was consulted throughout the development of this report and provided opportunity to comment and input prior to submission.
Key takeaways
- Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality around the world. Cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is a primary driver of ASCVD. Elevated LDL-C, though, can be effectively managed, suggesting that a proportion of ASCVD’s burden is avoidable. Our objective was to estimate the overall burden of ASCVD, and the share of this burden LDL-C contributes towards.
- ASCVD results in 261 million disability-adjusted life years (DALYs) globally each year. ASCVD is also responsible for approximately Int$680 billion in annual direct healthcare spending worldwide. When considering indirect costs—that is, foregone economic activity due to morbidity and mortality and as well as informal caregiving costs—ASCVD’s total economic burden almost triples, up to Int$1.4 trillion.
- Subject to data availability and limitations described in the report, we estimate that elevated LDL-C contributes towards approximately Int$230 billion of ASCVD’s global direct healthcare costs, and up to Int$480 billion to its total direct and indirect costs.
- In our core study countries, the total national direct and indirect cost of ASCVD ranged from $7.5 billion per year in the Netherlands to $434.3 billion per year in the US. LDL-C was associated with approximately one-third of these costs—much of which could be avoided through better management of LDL-C.
- In most places, ASCVD’s indirect costs are more substantial than its direct costs, with this result being primarily driven by productivity losses due to mortality and informal care costs.
- Moderate-risk groups, from “near optimal” through “borderline-high” (2.6–4.1 mmol/L) accounted for a majority (52%) of the overall cost burden. Even though per-patient burden increased with higher LDL-C, the aggregate burden was driven by the larger number of patients in the moderately elevated range.