Impact of standardized multicomponent management on healthcare utilization and costs among patients with cardiovascular disease: a longitudinal study
Y Ni, W Cao, Q Zhang, G YouAbstract
Background
Cardiovascular disease (CVD) remains a major driver of healthcare utilization and expenditure, especially in ageing populations. Although guideline-oriented management emphasizes lifestyle modification, psychosocial support, and appropriate pharmacotherapy, evidence is limited on which combinations of management components are most informative for reducing outpatient and inpatient economic burden.
Objective
To identify standardized, multicomponent management packages that are most strongly associated with lower healthcare utilization and costs among adults with diagnosed CVD.
Methods
We analyzed longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011–2018 and included 2,982 respondents with diagnosed CVD. We operationalized six non-pharmacological management domains (i.e., physical activity level, social participation, emotion management, cognitive function, family support, and BMI) and four treatment patterns (traditional Chinese medicine [TCM], Western medicine, combined TCM–Western therapy, and other), yielding 319 feasible management packages. For outpatient visits and hospitalization, logistic regression models were estimated and compared using the area under the receiver operating characteristic curve (AUC) to select the best-discriminating package. Quantile regression models were used for outpatient and inpatient expenditures, and predictive performance was compared using mean absolute error (MAE) to select the best-performing packages.
Results
For outpatient visit, package combining emotion management, family support, and combined TCM–Western therapy (β=-0.375，0.025，0.344，respectively; P < 0.001，0.045，0.031, respectively) showed the highest discrimination (AUC = 0.660). For outpatient expenditures, packages combining emotion management with social participation (β = −1.583, P < 0.001; MAE = 3.437) or with cognitive function (β = −1.547; MAE = 3.436) achieved the best predictive accuracy and were associated with lower predicted costs. For hospitalization, emotion management (β = −0.293; 95% CI −0.479 to −0.108) and physical activity (β = −0.174; 95% CI −0.291 to −0.056) were the strongest protective components. For inpatient expenditures, the best-performing package combined physical activity, family support, and medication-related management (MAE = 4.930); physical activity was associated with lower costs (β = −0.777; 95% CI −1.522 to −0.033), whereas family support (β = 0.175, 95% CI 0.031 to 0.318) and medication-related management (β = 1.752; 95% CI −0.542 to 4.045) showed positive but less consistent associations.
Conclusions
Management packages centered on emotion management were most consistently associated with lower healthcare utilization risk and reduced cost burden for CVD patients. For inpatient outcomes, the inclusion of physical activity in these packages further strengthened this association.