Estimating the indirect economic burden of elevated lipoprotein(a): A 5-year simulation of cardiovascular events and associated patient and caregiver costs.

Background: Elevated lipoprotein(a) (Lp[a]) is an independent, causal, genetic risk factor for atherosclerotic cardiovascular disease (ASCVD). Data show that a substantial economic burden is imposed by ASCVD; however, there is a paucity of studies evaluating the economic burden of ASCVD events associated with elevated Lp(a). This study estimated the indirect economic burden of elevated Lp(a) in the primary prevention setting. Methods: A Markov model simulated ASCVD events (myocardial infarction, stroke, and cardiovascular death) and associated indirect costs (patient and caregiver) across Lp(a) groups (<60 nmol/L, ≥60-<105 nmol/L, ≥105-<150 nmol/L, ≥150-<190 nmol/L, and ≥190 nmol/L) over 5 years. Results: Compared with the Lp(a) <60 nmol/L group, the Lp(a) ≥150 nmol/L group in the model had an estimated 42.4% higher indirect costs, representing an estimated incremental indirect cost of $253 million over 5 years or $506 per person per year. The model, based on predicted ASCVD events, suggested that the majority (68.8%) of incremental indirect costs were patient-related, comprising productivity loss from premature cardiovascular death (37.9%), disability/early retirement (17.3%), acute/post-event productivity loss (9.6%), and foregone leisure time (3.9%). Caregiver costs accounted for 31.2% of estimated incremental indirect costs in the model: unpaid caregiving time (17.3%), caregiver income loss (11.7%), and paid caregiving services (2.2%). Conclusions: This simulation model-based study projected that increasing Lp(a) levels were associated with more ASCVD events and higher indirect costs, primarily driven by patient productivity loss and caregiver burden. These findings suggest that the broader societal impact of elevated Lp(a) extends beyond the healthcare system.