Cardiovascular disease exerts an economic toll on the country. A recent Canadian study assesses the impact of cardiovascular disease treatment and prevention on healthcare spending by the year 2050.
Cardiovascular disease (CVD) is the leading cause of death in most developed countries. Although there has been a decline in the prevalence of cardiovascular diseases over the decades, it still causes a significant economic burden on these countries. In Canada, cardiovascular disease ranked first in direct health cost, reaching nearly C$12 billion, with heart attacks and heart failures being responsible for most of the cost associated with hospitalization.
Prevention or Treatment?
Different prevention methods have been designed to reduce the incidence of the disease which will, in turn, reduce their economic burden. Irrespective of the prevention methods used by different countries, the World Health Organization has adopted a target of reducing worldwide chronic disease (including CVD) mortality by 25% by the year 2025. This is significant and it would be beneficial for governments to assess the economic impact of this reduction in order to be able to make appropriate decisions concerning patient care and at the same time minimize healthcare cost.
In this light, researchers in Quebec, Canada used computer models to forecast the use and cost of healthcare from cardiovascular disease by the year 2050. In this study that was published in PLOS ONE, Boisclair and colleagues used surveys and administrative data on the cost of hospital stays and physician compensation to project the use and cost associated with health care for each individual in the province of Quebec. The researchers used two alternative scenarios (“treatment” or “mortality-based scenario” and “prevention” or “incidence-based scenario”) about the future evolution of cardiovascular disease in Quebec residents to determine:
- Savings in healthcare costs associated with physician visits and hospital stays
- Increases in life expectancy and years of life saved
- Monetary value of healthcare cost savings and life expectancy increases in the year 2050.
Both scenarios were based on the WHO 2025 target of 25% reduction in chronic disease. In the mortality-based scenario, while leaving the incidence of the disease unchanged, they determined the decrease in cardiovascular disease as a result o a decrease in mortality. In the incidence-based scenario, mortality risk remained unchanged while decrease in cardiovascular disease was determined from incidence alone.
Reducing the Mortality Rate Results in Health Care Savings
The researchers projected an increase in the proportion of individuals 30 years or older with cardiovascular disease, with hypertension increasing from 29% in 2012 to 41 % in 2050 and and heart disease increasing from 7.6% in 2012 to 9.5% in 2050. This translated to an increase in cost of hospitalization and physician consultations. While the incidence-based scenario was shown to lower this increase in cost, the mortality-based scenario increased the cost.
In terms of life expectancy, the mortality-based scenario showed an additional 0.3 years of life for Quebec residents at age 65, saving a total of 753,300 years of life while the incidence-based scenario showed similar result but at a slower pace leading to a 433,200 years of life saved by 2050. In monetary terms and taking the number of years of life saved into consideration, the researchers were able to project a C$69.6 billion savings using the mortality-based scenario while projected savings for the incidence-based scenario was C$38.2 billion.
These results show that addressing cardiovascular disease mortality directly would lead to more cost savings than addressing it through incidence reduction. Despite this difference in cost savings, tackling cardiovascular disease both through incidence reduction and by addressing mortality would lead to greater cost savings for the Quebec government.There is therefore the need for more prevention methods as well as increased and renewed efforts to treat new and existing cases of cardiovascular disease in order to maintain an economic balance.
Written by Asongna T. Folefoc
Reference: Boisclair D, De´carie Y, Laliberte´-Auger F, Michaud P-C, Vincent C (2018) The economic benefits of reducing cardiovascular disease mortality in Quebec, Canada. PLoS ONE 13(1): e0190538. https://doi.org/10.1371/journal. pone.0190538 E