Blog | Friday, January 28, 2011

QD: News Every Day--Cardiac care costs could triple by 2030

Real total direct medical costs of cardiovascular disease (CVD) could triple, from $273 billion to $818 billion (in 2008 dollars) by 2030. Real indirect costs, such as lost productivity among the employed and unpaid household work, could increase 61%, from $172 billion in 2010 to $276 billion.

Results appeared in a policy statement of the American Heart Association.

CVD is the leading cause of mortality and accounts for 17% of national health expenditures, according to the statement. How much so? U.S. medical expenditures rose from 10% of the Gross Domestic Product in 1985 to 15% in 2008. In the past decade, the medical costs of CVD have grown at an average annual rate of 6% and have accounted for about 15% of the increase in medical spending.

The spending is associated with greater life expectancy, "suggesting that this spending was of value," the authors wrote. But as the population ages, direct treatment costs are expected to increase substantially, even though lost productivity won't, since seniors are employed at lower rates.

If current prevention and treatment rates remain steady, CVD prevalence will increase by about 10% over the next 20 years. The estimate reflects an aging population, and one that is increasingly Hispanic. To prepare for future cardiovascular care needs, the American Heart Association projected future costs. By 2030, 40.5% (116 million) of the population is projected to have some form of CVD.

So, prevalence estimates for hypertension, CHD, heart failure, and stroke were generated using data from the 1999 to 2006 National Health and Nutrition Examination Survey. Medical cost projections were derived from the 2001 to 2005 Medical Expenditure Panel Survey. This methodology avoided double counting of costs for patients with multiple cardiovascular conditions.

Overall, hypertension has the greatest projected medical cost. The increased prevalence of hypertension is in part attributable to the aging of the population, but there's a 15% relative increase in its prevalence after age adjustment. Increasing body mass index contributed to more than 50% of the increase in hypertension.

"Reversing the obesity epidemic will play a pivotal role in favorably impacting the projected hypertension trends," the authors wrote. "Hypertension accounts for 18% of CVD deaths in Western countries and is a major risk factor for stroke, [coronary heart disease] and heart failure. Thus, the total medical costs for hypertension inclusive of these downstream diseases are approximately double the cost of hypertension itself, making hypertension a particularly valuable target to modify the future total costs of CVD."

But the projections don't necessarily have to come to pass, according to the statement. "Although these projections are sobering, they need not become reality, because CVD is largely preventable," the authors wrote. "Therefore, a greater focus on prevention may alter these CVD projections in the future."

For example, emerging evidence shows that prevention and awareness should begin earlier in life than it does now, as would lower sodium intake (by 3 g per day), awareness of genetic variations that lower cholesterol, better biomarkers such as C-reactive protein, and imaging tests such as coronary artery calcium scoring.

Looming shortages in primary care, but also in the fields of pharmacy and in cardiology, will also diminish care.