The Economic Impact of Cardiovascular Disease

Jos Leal Acknowledgements: Ramn Luengo-Fernndez, Alastair Gray

Health Economics Research Centre

The Business of Cardiac Services Mayfair Conference Centre, London Thursday 1st June 2006

Overview
Cardiovascular disease:
Background & definitions.

Economic burden of CVD:

EU and the UK; Patterns of care across EU; CHD and cerebrovascular diseases.

What can we learn?

Healthcare expenditure in the future; Cerebrovascular disease.

Conclusion
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Background
CVD is the largest cause of sickness and morbidity, and a major cause of death and premature death and of reduced quality of life for the citizens of the EU:
1.5 million deaths in EU; Coronary heart disease (CHD) accounts for 40%; Cerebrovascular disease accounts for 25%.

In the UK, 238,365 people died due to CVD in 2002. No study had estimated impact of CVD in the EU economy using a cost-of-illness study. Commissioned by the British Heart Foundation and European Heart Network.

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Objective
Estimate the economic costs of CVD for the EU from a societal perspective. Includes: health care costs, informal care costs, and productivity losses due to morbidity and premature death. Estimate the proportion of CVD costs due to CHD and cerebrovascular diseases.

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Definitions
Cardiovascular disease:
ICD-10 category I00-I99; Acute & chronic rheumatic diseases, hypertensive, heart failure, etc.

Of which: Coronary heart disease (CHD):

ICD-10 category I20-I25; Angina, MI, chronic IHD, other acute IHD.

Cerebrovascular disease:
ICD 10 category I60-I69; Sub&intra haemmorrhage, stroke, infarction, etc. HERC

Methods
Annual time-frame. Costs were expressed in 2003 Euros (). Sources searched: WHO mortality database, WHO HFA database, OECD Health data, EUROSTAT, ILO-Laborsta database, national ministries, national statistical institutes
Leal J., Luengo-Fernandez R., Gray A., Petersen S., Rayner R. Economic costs of cardiovascular disease in the European Union. European Heart Journal (doi:10.1093/eurheartj/ehi733) Luengo-Fernandez R., Leal J., Gray A., Petersen S., Rayner R. The cost of cardiovascular diseases in the United Kingdom. Heart (doi:10.1136/hrt.2005.072173) HERC

Results EU economy
Health care 104.5bn (63%)

Total 169bn

Mortality 24.4bn (14%) Informal care 29bn (17%) Morbidity 10.7bn (6%)

Germany and the UK represented 52% of all costs, whereas Malta and Cyprus represented less than 0.1% of total costs. HERC

Results UK economy
Health care 16.4bn (60%)

Total 26bn

Mortality 3.7bn (13%) Morbidity 2.6bn (9%)

Informal care 4.8bn (18%)

522mn hours of unpaid care were provided to CVD sufferers by friends and relatives. 2.2mn working years were lost due to CVD-premature death. 67.3mn working days were lost to CVD-related illness. HERC

Total cost per capita (adjusted for cost of living)

Malta Latvia Cyprus Lithuania Ireland Estonia Hungary Poland Slovakia Spain Slovenia Portugal Czech Rep. Denmark Greece Belgium France Italy Finland Luxemb. Austria Netherland Sweden UK Germany Average EU 38 51 74 90 91 96 96 100 107 111 113 119 159 162 174 194 198 206 208 220 231 240 261 342 379 230

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Healthcare expenditure
Represented 12% of total health care spending:
Varying from 2% in Malta to 18% in the UK.

In-patient care accounted for 59bn (57%):

Varying from 35% in Slovakia to 77% in the UK.

Pharmaceuticals were also a major cost component accounting for 28bn (27%):
Varying from 13% in Poland, 18% in the UK, to 52% in Portugal.

Primary, outpatient, and emergency care represented 16% of total costs:

Varying from 6% in the UK to 32% in Slovakia. HERC

Patterns of healthcare in the EU

EU UK Sweden Portugal Italy Hungary France Czech Rep. 0% 20% 40% 60% 80% 100% Primary care Outpatient care A&E Inpatient care Medications

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CHD and cerebrovascular

Coronary heart disease:
Cost the EU economy over 45bn a year: one-quarter of the overall cost of CVD; 51% of these costs being incurred in health care, a lower proportion than for CVD.

Cerebrovascular disease:
cost the EU in excess of 34 billion a year: around one-fifth of the overall cost of CVD; 62% of these costs being incurred in health care.

In the UK:
CHD cost 7.9bn 45% in health care; Cerebrovascular cost 7.6bn 65% in health care. HERC

What can we learn?

Need for more comparable data across EU. UK has reliable and up-to-date data on health care use, however,
More up-to-date information is still needed for:
GP and outpatient consultations; Pharmaceutical expenditure per condition; Informal care across diseases.

The heterogeneity found across the EU leads to question whether the UK also differs across its regions. What can we expect in terms of health care expenditure in the future? The impact of cerebrovascular disease in the UK. HERC

Future healthcare expenditure?

Health care costs expected to rise:
Health sector inflation:
Rises faster than the economy as a whole.

Increase use of preventive measures:

Premorbid medication (Rothwell 2004).

Higher emphasis on prevention may shift non-fatal events from younger to older people:
Need to improve the capacity of services for older people; Disability & complications: increase in length of stay and need for long-term care.

Rise of other conditions like obesity and diabetes. HERC

Inflation
130

Inflation (Index year: 2000)

120

Overall inflation Health sector Pharmaceuticals Hospital services

110

100 2000

2001

2002

2003

2004

2005

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Hospital stay
1000

Total hospital bed days (thousands)

900

800

700

600

500 1990

1992

1994

1996

1998

2000

2002

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Medication
2500

Pharmaceutical sales ( millions)

2000

1500

1000

500

0 1990

1992

1994

1996

1998

2000

2002

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Cerebrovascular disease in the UK

Impact of cerebrovascular disease has been underestimated previously. High burden on health care:
5.2 billion compared to 3.8billion due to CHD (2004); 5.7m bed days compared to 3.9m bed days due to CHD; Acute cerebrovascular at least as frequent as acute coronary events (Rothwell 2005). Males:

Deaths due to CHD and cerebrovascular:

80% of CHD deaths >65 years; 90% of cerebrovascular deaths >65 years. 94%-95% deaths >65 years.

Females:

Need for research about appropriate primary and secondary prevention strategies in older age groups.

Coronary events occur at older ages (Rothwell 2005).

Conclusion
CVD is a major public health problem in EU and the UK:
169bn in the EU with the UK accounting for 21% of the total costs (26bn); Non-health care costs have a considerable impact (40%).

Cerebrovascular disease has a big impact on total CVD costs:

In the UK, it places a higher burden on healthcare than CHD.

Other diseases still compose a significant proportion of total costs:

Heart failure, renovascular disease, hypertension, etc.

Further research to determine the burden in each region of the UK:

Data is required. HERC

Final comments
What are we getting out of healthcare spending?
How can we measure health improvement? Is 18% of total HC expenditure too much or too little? Where is the trade-off? Where are the losers? Can we improve the efficiency of healthcare delivered?
Cost-effectiveness evidence.

Health improvement is not the product of health care alone:

Education; Lifestyle; Housing; Economic welfare of the poorest groups in society. HERC

Health Economics Research Centre

A copy of this presentation can be found in our website:

www.herc.ox.ac.uk

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