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The Economic I mpact ofCardiovascular Disease

Jos LealAcknowledgements: Ramn Luengo-Fernndez, Alastair Gray

Health Economics Research Centre

The Business of Cardiac Services

Mayfair Conference Centre, LondonThursday 1st June 2006


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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 ofreduced 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 EUeconomy using a cost-of-illness study.

Commissioned by the British Heart Foundation andEuropean 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.


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Methods Annual time-frame.

Costs were expressed in 2003 Euros ().

Sources searched: WHO mortality database, WHO HFA

database, OECD Health data, EUROSTAT, ILO-Laborstadatabase, national ministries, national statisticalinstitutes

Leal J., Luengo-Fernandez R., Gray A., Petersen S., Rayner R.Economic costs of cardiovascular disease in the EuropeanUnion. 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)


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Results EU economy

Mortality

24.4bn (14%)

Morbidity

10.7bn (6%)Informal care29bn (17%)

Health care

104.5bn (63%)

Germany and the UK represented 52% of all costs, whereas Malta and

Cyprus represented less than 0.1% of total costs.

Total

169bn


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Results UK economy

Mortality

3.7bn (13%)

Morbidity

2.6bn (9%)Informal care4.8bn (18%)

Health care

16.4bn (60%)

522mn hours of unpaid care were provided to CVD sufferers by friendsand relatives.

2.2mn working years were lost due to CVD-premature death. 67.3mn working days were lost to CVD-related illness.

Total

26bn


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Total cost per capita

(adjusted for cost of living)

230

379 342

261 240

231 220

208

206 198

194

174 162

159 119

113

111 107

100

96 96

91 90

74

51 38

Average EU

GermanyUK

SwedenNetherland

Austria

Luxemb.Finland

Italy

FranceBelgium

Greece

DenmarkCzech Rep.

PortugalSlovenia

Spain

SlovakiaPoland

Hungary

EstoniaIreland

LithuaniaCyprus

Latvia

Malta


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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 componentaccounting 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.

P tt f h lth


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Patterns of healthcare

in the EU

0% 20% 40% 60% 80% 100%

Czech Rep.

France

Hungary

Italy

Portugal

Sweden

UK

EU

Primary care

Outpatient careA&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 theoverall cost of CVD;

51% of these costs being incurred in health care, a lowerproportion than for CVD.

Cerebrovascular disease:

cost the EU in excess of 34 billion a year: around one-fifth ofthe 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.


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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 questionwhether the UK also differs across its regions.

What can we expect in terms of health care expenditurein the future?

The impact of cerebrovascular disease in the UK.


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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 fromyounger to older people:

Need to improve the capacity of services for older people;

Disability & complications: increase in length of stay and need forlong-term care.

Rise of other conditions like obesity and diabetes.


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Inflation

100

110

120

130

2000 2001 2002 2003 2004 2005

Inflation(Indexye

ar:2000)

Overall inflation

Health sectorPharmaceuticals

Hospital services


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Hospital stay

500

600

700

800

900

1000

1990 1992 1994 1996 1998 2000 2002

Totalhospitalbeddays(thousands

)


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Medication

0

500

1000

1500

2000

2500

1990 1992 1994 1996 1998 2000 2002

Pharmac

euticalsale

s(millions)

C b l di


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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). Deaths due to CHD and cerebrovascular:

Males: 80% of CHD deaths >65 years;

90% of cerebrovascular deaths >65 years. Females:

94%-95% deaths >65 years.

Coronary events occur at older ages (Rothwell 2005).

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


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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.


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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.


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Health Economics


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Health Economics

Research Centre

A copy of this presentation can be found

in our website: www.herc.ox.ac.uk

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