The subject has been widely addressed recently due to etiological, clinical and therapeutic advances. However, do we really know everything about obstructive hypertrophic cardiomyopathy? Gaps, detailed in a recent study, persist.
The authors of the literature review proposed by BMC Cardiovascular Disorders describe obstructive hypertrophic cardiomyopathy (HOCM) as a “human, clinical and economic burden”. Patients suffering from this condition require repeated hospitalizations, expensive care, generally cannot work and, due to the genetic nature of this disease and their daily dependence, place a considerable burden on their families.
If, in recent years, etiological and therapeutic research has allowed great advances, the overall clinical and economic question has been less often taken into account. This is what prompted Michael Butzner and coll. (San Francisco, United States) to carry out an analysis of the literature on the subject, firstly taking into account 179 articles, then secondarily 16 other studies by American, Japanese, French, German, Italian, Spanish, British and Canadian authors. Included studies reported outcomes related to efficacy, safety and/or quality of life, and treatments including cardiac myosin inhibitors (CMIs), beta-blockers (BBs), cardiac myosin inhibitors (CMIs), calcium antagonists (CCI), disopyramide, and interventions, such as septal reduction (SRT), were used as comparators. The analysis of the results was carried out in two parts: hypertrophic cardiomyopathy of all types and causes (HCM) and obstructive hypertrophic cardiomyopathy (HCM).
This work made it possible to compile information on the epidemiology of HCM and CMHO. For HCM, if the global prevalence (from 3.1 to 10 per 10,000), American (from 3.8 to 6.6 per 10,000), German and British is well documented, precise information is lacking for France, Italy, Spain, Canada and Japan. Regarding CMHO, global epidemiological data are lacking, while studies have been carried out in a few countries: United States (incidence of 1.5 per 10,000 in 2019), Germany, United Kingdom and Japan.
The authors point out that estimates of the prevalence and incidence of HCM and CMHO do not necessarily represent reality, as the disease is often misdiagnosed or under-recognized in clinical practice. It is estimated that only 10% of HCM cases are clinically identified, and only 6% of identified cases are symptomatic. Regarding the diagnosis of CMHO, the authors advocate the adoption of similar criteria in all learned societies and in all countries.
Up to USD 35,000 per year
The second aspect of this literature review concerned the economic, clinical (taking into account the burden of symptoms and hospitalizations) and human impact of CMH and CMHO. For the latter and among the selected countries, we only had information for two of them: Japan and the United States.
Thus, according to an analysis of medical claims in the United States between 2009 and 2019, and compared to matched controls, a diagnosis of CMHO was associated with substantial increases in all-cause hospitalizations, hospital days, outpatient visits and total health care costs, resulting in an additional incremental cost of $20,000 per year compared to an unaffected person. When considering patients with symptomatic CMHO, healthcare resource utilization and costs were significantly higher compared to matched controls, and the incremental cost increased to $35,000 per year.
This article was first published on Mediquality.net
