Economic Burden Of Cardiovascular Disease Research Articles

PCR221 Real-World Adherence to Anti-PCSK9 Monoclonal Antibody (mAb) and Its Impact on Economic Burden of Cardiovascular Diseases in Patients with Hypercholesterolemia: A Retrospective Cohort Study in China

PCR221 Real-World Adherence to Anti-PCSK9 Monoclonal Antibody (mAb) and Its Impact on Economic Burden of Cardiovascular Diseases in Patients with Hypercholesterolemia: A Retrospective Cohort Study in China

The State of Cardiac Rehabilitation in Saudi Arabia: Barriers, Facilitators, and Policy Implications.

Cardiovascular disease (CVD) is a critical public health issue in Saudi Arabia, where it is the leading cause of death. The economic burden of CVD in the country is expected to triple by 2035, reaching $9.8 billion. This paper provides an overview of CVD in Saudi Arabia and its risk factors, impact on healthcare, and effects on patients' quality of life. The review emphasizes the potential of cardiac rehabilitation (CR) programs in addressing the CVD epidemic. CR programs have been shown to reduce morbidity, mortality, and hospital readmissions while improving patients' cardiovascular health and overall well-being. However, these programs are underutilized and inaccessible in Saudi Arabia. The paper highlights the urgent need for CR programs in the country and suggests key strategies for implementation. These include increasing patient referrals, tailoring programs to individual needs, enhancing patient education, and making CR accessible through home-based options. Fostering multidisciplinary collaboration and developing tailored guidelines for Arab countries can further enhance the impact of CR programs. In conclusion, this review underscores the vital importance of comprehensive CR programs in Saudi Arabia to combat the rising CVD burden, improve patient quality of life, and align with the goals of the Saudi 2030 Vision for a healthier society.

Societal health and economic burden of cardiovascular diseases in the population with type 2 diabetes in Qatar. A 10-year forecasting model.

To predict the future health and economic burden of cardiovascular disease (CVD) in type 2 diabetes (T2D) in Qatar. A dynamic multistate model was designed to simulate the progression of fatal and non-fatal CVD events among people with T2D in Qatar aged 40-79 years. First CVD events [i.e. myocardial infarction (MI) and stroke] were calculated via the 2013 Pooled Cohort Equation, while recurrent CVD events were sourced from the REACH registry. Key model outcomes were fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years, total direct medical costs and total productivity loss costs. Utility and cost model inputs were drawn from published sources. The model adopted a Qatari societal perspective. Sensitivity analyses were performed to test the robustness of estimates. Over 10 years among people with T2D, model estimates 108 195 [95% uncertainty interval (UI) 104 249-112 172] non-fatal MIs, 62 366 (95% UI 60 283-65 520) non-fatal strokes and 14 612 (95% UI 14 472-14 744) CVD deaths. The T2D population accrued 4 786 605 (95% UI 4 743 454, 4 858 705) total years of life lived and 3 781 833 (95% UI 3 724 718-3 830 669) total quality-adjusted life years. Direct costs accounted for 57.85% of the total costs, with a projection of QAR41.60 billion (US$11.40 billion) [95% UI 7.53-147.40 billion (US$2.06-40.38 billion)], while the total indirect costs were expected to exceed QAR30.31 billion (US$8.30 billion) [95% UI 1.07-162.60 billion (US$292.05 million-44.55 billion)]. The findings suggest a significant economic and health burden of CVD among people with T2D in Qatar and highlight the need for more enhanced preventive strategies targeting this population group.

Economic burden of cardiovascular diseases in the European Union: a population-based cost study.

Cardiovascular disease (CVD) impacts significantly health and social care systems as well as society through premature mortality and disability, with patients requiring care from relatives. Previous pan-European estimates of the economic burden of CVD are now outdated. This study aims to provide novel, up-to-date evidence on the economic burden across the 27 European Union (EU) countries in 2021. Aggregate country-specific resource use data on morbidity, mortality, and health, social and informal care were obtained from international sources, such as the Statistical Office of the European Communities, enhanced by data from the European Society of Cardiology Atlas programme and patient-level data from the Survey of Health, Ageing and Retirement in Europe. Country-specific unit costs were used, with cost estimates reported on a per capita basis, after adjustment for price differentials. CVD is estimated to cost the EU €282 billion annually, with health and long-term care accounting for €155 billion (55%), equalling 11% of EU-health expenditure. Productivity losses accounted for 17% (€48 billion), whereas informal care costs were €79 billion (28%). CVD represented a cost of €630 per person, ranging from €381 in Cyprus to €903 in Germany. Coronary heart disease accounted for 27% (€77 billion) and cerebrovascular diseases for 27% (€76 billion) of CVD costs. This study provides contemporary estimates of the wide-ranging impact of CVD on all aspects of the economy. The data help inform evidence-based policies to reduce the impact of CVD, promoting care access and better health outcomes and economic sustainability.

Projecting the Health and Economic Burden of Cardiovascular Disease Among People with Type 2 Diabetes, 2022-2031.

The aim was to project the health and economic outcomes of cardiovascular disease (CVD) among people with type 2 diabetes from Australian public healthcare and societal perspectives over the next decade. A dynamic multistate model with yearly cycles was developed to project cardiovascular events among Australians with type 2 diabetes aged 40-89 years from 2022 to 2031. CVD risk (myocardial infarction [MI] and stroke) in the type 2 diabetes population was estimated using the 2013 pooled cohort equation, and recurrent cardiovascular event rates in the type 2 diabetes with established CVD population were obtained from the global Reduction of Atherothrombosis for Continued Health (REACH) registry. Costs and utilities were derived from published sources. Outcomes included fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total healthcare costs, and total productivity losses. The annual discount rate was 5%, applied to outcomes and costs. Between 2022 and 2031, a total of 83,618 non-fatal MIs (95% uncertainty interval [UI] 83,170-84,053) and 58,774 non-fatal strokes (95% UI 58,458-59,013) were projected. Total years of life lived and QALYs (discounted) were projected to be 9,549,487 (95% UI 9,416,423-9,654,043) and 6,632,897 (95% UI 5,065,606-7,591,679), respectively. Total healthcare costs and total lost productivity costs (discounted) were projected to be 9.59 billion Australian dollars (AU$) (95% UI 1.90-30.45 billion) and AU$9.07 billion (95% UI 663.53 million-33.19 billion), respectively. CVD in people with type 2 diabetes will substantially impact the Australian healthcare system and society over the next decade. Future work to investigate different strategies to optimize the control of risk factors for the prevention and treatment of CVD in type 2 diabetes in Australia is warranted.

EE195 Economic Burden of Cardiovascular Disease Among Commercially Insured Adults Diagnosed With Colorectal Cancer in the United States

EE195 Economic Burden of Cardiovascular Disease Among Commercially Insured Adults Diagnosed With Colorectal Cancer in the United States

The Burden of Cardiovascular Disease Attributable to Modifiable Risk Factors and Cost-effectiveness Analysis of IraPEN Program in the General Population of Iran.

Background: Cardiovascular diseases (CVDs) contribute to over 30% of deaths worldwide and more than 40% in Iran in 2019. Establishing a cost-effective program to control cardiovascular diseases is essential for any country. This study aimed to estimate the cost-effectiveness of the primary prevention program (IraPEN) for cardiovascular diseases in Iran. Methods: This methodological cost-effectiveness study was performed to estimate the cost-effectiveness of the IraPEN program by modifying cardiovascular disease risk factors in the IraPEN program. We calculated the economic burden of CVDs risk factors from 2016 to 2018 in 4 pilot cities in Iran. We observed 160,833 individuals for 2 years to measure the economic burden of cardiovascular diseases. To estimate the variation of the 1-year risk of cardiovascular illnesses, and according to the study's goal of estimating the 1-year risk of cardiovascular disease, only 36,631 people remained in the study who compiled the program's instruction for 1 year. Propensity scores were used to consider the effect of those excluded from the study. The 10-year risk of CVDs was estimated by the laboratory tests and information registered in the population’s electronic records. To evaluate the effect of the IraPEN program in reducing the risk factors for cardiovascular diseases, major CVD risk factors were studied by the World Health Organization formula (whocvdrisk) and cardiovascular diseases risk scoring. We used the 10-year risk for CVDs to conduct a cost-effectiveness analysis in terms of cost per disability-adjusted life-year (DALY) saved. Results: According to estimates of the 1-year relative risk reduction in cardiovascular disease, the results showed that relative risk reductions for men and women were 0.74 and 0.65, respectively. Hence, about 174,088 annual acute CVDs events reduction would be expected; this decrease is predicted for men (93,034) more than women (81,054) for the total population of Iran. The total cost of treatment for people with cardiovascular diseases was 165 USD for coronary heart disease or stroke per individual. All risk factors were further reduced in women than men, except for smoking. DALYs averted was 1057.66 for samples who were in the study for a year (36631 samples). The total cost per averted DALY was 47.16. Conclusion: Estimating the costs associated with disease prevention programs is more important in developing countries. The most cost-effective strategies have been preventive therapies that target high-risk individuals. PEN risk reduction programs for primary prevention such as Ira-pen are highly cost-effective and efficient in low- and middle-income countries.

EPH79 Projections of Future Health and Economic Burden of Cardiovascular Disease Among Patients with Type 2 Diabetes Mellitus in Australia. Estimates up to 2030

Type 2 diabetes mellitus (T2DM) is one of the critical modifiable risk factors that contribute to the burden of cardiovascular disease (CVD). The purpose of this study was to predict the future health and economic burden of CVD among patients with T2DM in Australia from 2020 to 2030.

A multi-point heart rate monitoring using a soft wearable system based on fiber optic technology

Early diagnosis can be crucial to limit both the mortality and economic burden of cardiovascular diseases. Recent developments have focused on the continuous monitoring of cardiac activity for a prompt diagnosis. Nowadays, wearable devices are gaining broad interest for a continuous monitoring of the heart rate (HR). One of the most promising methods to estimate HR is the seismocardiography (SCG) which allows to record the thoracic vibrations with high non-invasiveness in out-of-laboratory settings. Despite significant progress on SCG, the current state-of-the-art lacks both information on standardized sensor positioning and optimization of wearables design. Here, we introduce a soft wearable system (SWS), whose novel design, based on a soft polymer matrix embedding an array of fiber Bragg gratings, provides a good adhesion to the body and enables the simultaneous recording of SCG signals from multiple measuring sites. The feasibility assessment on healthy volunteers revealed that the SWS is a suitable wearable solution for HR monitoring and its performance in HR estimation is strongly influenced by sensor positioning and improved by a multi-sensor configuration. These promising characteristics open the possibility of using the SWS in monitoring patients with cardiac pathologies in clinical (e.g., during cardiac magnetic resonance procedures) and everyday life settings.

Does social isolation, social support or loneliness influence health or well-being after a cardiovascular disease event? A narrative thematic systematic review.

Identification of factors which influence health after a cardiovascular disease (CVD) event will assist with reducing the high health and economic burden of CVD. We undertook a systematic review to investigate the association between social health (lower social isolation, higher social support and lower loneliness) and health and well-being after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched until June 2020. Two reviewers undertook title/abstract screen. One reviewer undertook full-text screen and data extraction. A second author either independently extracted or checked data. Narrative thematic analysis was undertaken. Of the 752 unique records retrieved, 39 papers from 29 studies met our inclusion criteria. Included studies recruited between 10 and 1,455 participants, aged 12-96years, and the majority were male. Greater social health was consistently associated with better mental health outcomes (lower depressive symptoms, anxiety symptoms and psychological distress). Lower social isolation and higher social support were associated with the extent to which patient needs were being met. Living situation was not associated with mental health outcomes, and being married or living with someone was associated with greater medication adherence. Our systematic review demonstrates that greater social health is associated with better mental health outcomes and met patient needs among cardiac patients. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies when assessing health outcomes among CVD patients. Our review highlights the need for more research focused on women and the importance of gender-disaggregated reporting. Further assessment is required to evaluate whether loneliness is associated with health and well-being outcomes after a CVD event.

Epidemiology and Economic Burden of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in Spain: A Systematic Review.

IntroductionCardiovascular disease (CVD) is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus (T2DM). The objectives of this systematic literature review were to identify and synthesize published data describing the epidemiology and mortality of CVD in the T2DM population and the associated economic burden.MethodsWe conducted a systematic review searching the PubMed and MEDES databases from 2009 to 2019 using predefined selection criteria. Peer-reviewed observational studies reporting primary or secondary data on CVD prevalence, incidence, mortality, resource use and costs in patients with T2DM in Spain, written in English and Spanish, were included. Data were tabulated and summarized descriptively.ResultsOf 706 articles identified, 52 were included in the review. Most studies were based on data from hospital discharge databases and registries. The reported prevalence of CVD among patients with T2DM ranged from 6.9 to 40.8%. The prevalence of coronary heart disease ranged from 4.7 to 37%, stroke from 3.5 to 19.6%, peripheral artery disease from 2.5 to 13.0%, and heart failure from 4.3 to 20.1%. In-hospital CVD mortality rates ranged from 5.6 to 10.8%. Direct costs due to CVD in hospitalized patients with T2DM were increased (> 50%) compared with patients without CVD. No studies analysed indirect costs of CVD in patients with T2DM.ConclusionsThe burden of CVD among patients with T2DM, combined with the elevated costs of care, highlights the importance of early prevention as part of integrated management of the disease to improve clinical and economic outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01060-8.

Identification of Health Expenditures Determinants: A Model to Manage the Economic Burden of Cardiovascular Disease

The purpose of this paper is to investigate the determinants influencing the costs of cardiovascular disease in the regional health service in Italy’s Apulia region from 2014 to 2016. Data for patients with acute myocardial infarction (AMI), heart failure (HF), and atrial fibrillation (AF) were collected from the hospital discharge registry. Generalized linear models (GLM), and generalized linear mixed models (GLMM) were used to identify the role of random effects in improving the model performance. The study was based on socio-demographic variables and disease-specific variables (diagnosis-related group, hospitalization type, hospital stay, surgery, and economic burden of the hospital discharge form). Firstly, both models indicated an increase in health costs in 2016, and lower spending values for women (p < 0.001) were shown. GLMM indicates a significant increase in health expenditure with increasing age (p < 0.001). Day-hospital has the lowest cost, surgery increases the cost, and AMI is the most expensive pathology, contrary to AF (p < 0.001). Secondly, AIC and BIC assume the lowest values for the GLMM model, indicating the random effects’ relevance in improving the model performance. This study is the first that considers real data to estimate the economic burden of CVD from the regional health service’s perspective. It appears significant for its ability to provide a large set of estimates of the economic burden of CVD, providing information to managers for health management and planning.

THE ECONOMIC BURDEN OF CARDIOVASCULAR DISEASES ASSOCIATED WITH UNHEALTHY DIET IN THE RUSSIAN FEDERATION IN 2016

Abstract Objective: To estimate the economic burden of cardiovascular diseases (CVD) attributable to unhealthy diet in the Russian Federation (RF) in 2016. Design and method: According to the ESSE-RF epidemiological study, the prevalence of excess consumption of salt, processed red meat and sugar-sweetened beverages (SSB) in the Russian population was recorded in 49.9%, 22.5 %, 8.6% surveyed, respectively. We first obtained CVD risk estimates for intakes of harmful foods (salt, processed red meat, SSB). The relative risks (RRs) of morbidity and mortality from CVD associated with unhealthy diet were identified through a literature search. Based on the data on the prevalence of excess salt intake, processed red meat and SSB consumption in the Russian population and RRs, the population attributable fractions (PAFs) was calculated for CVD. Associations were presented as RRs and PAFs with 95% CIs. To assess the economic burden, the proportion of the analyzed risk factors in the morbidity and mortality from CVD was determined, and then the proportion in the economic burden of the CVD. The direct costs of the health care system and losses in the economy due to morbidity and mortality from CVD associated with unhealthy diet were determined. The calculations were performed in Microsoft Excel 10.0. (Microsoft, USA). Results: The calculated PAR, associated with excess salt intake, for CVD mortality and morbidity was 5% and 7% respectively; for stroke: in mortality — 17%, in morbidity — 10%. The daily of processed red meat consumption determine 8.6% contribution to the morbidity of coronary heart disease. PAR of SSB consumption for CVD mortality and morbidity – 2%. The economic burden of CVD associated with an unhealthy diet in the Russian Federation in 2016 amounted to 204.2 billion rubles (2.9 billion €). Excessive salt intake makes the largest contribution to this burden. The losses in the economy due to premature mortality (177.2 billion rubles) prevail in the structure of the main burden. Direct medical expenses amounted to 26.9 billion rubles. Conclusions: The significant economic burden associated with preventable disease provides an economic rationale for action to reduce the prevalence of lifestyle-related risk factors.

ECONOMIC BURDEN OF CARDIOVASCULAR DISEASES ASSOCIATED WITH TOBACCO USE IN THE RUSSIAN FEDERATION IN 2016

Abstract Objective: To estimate the economic burden of cardiovascular diseases (CVD) associated with tobacco use in the Russian Federation (RF) in 2016, including the direct costs and the economic losses caused by reduced productivity. Design and method: The prevalence of tobacco use in the Russian population was determined in a ESSE-RF epidemiological study - 23.6%. The relative risks (RRs) of morbidity and mortality from CVD associated with tobacco use were identified through meta-analyzes and large studies. Based on the data on the prevalence of tobacco use in the Russian population and relative risks (RRs), the population attributable fractions (PAFs) was calculated for CVD. Associations were presented as RRs and PAFs with 95% CIs. PAF (%) = (P_exp (RR-1))/([P_exp (RR-1)] + 1), where: P_exp - the proportion of individuals in a population who are exposed to tobacco; RR - the relative risk of a specific outcome for a given exposure to a risk factor; To assess the economic burden, the proportion of the analyzed risk factor in the morbidity and mortality from CVD was determined, and then the proportion in the economic burden of the CVD. Then we estimated attributable costs by multiplying PAFs outcomes with estimated 2016 annual direct health care and indirect costs for CVD. We used data from the Federal State Statistics Service, parameters of Annual Forms of Federal Statistical Monitoring, the results of Program of state guarantees for free medical care and the corresponding diagnosis-related groups for 2016. The calculations were performed in Microsoft Excel 10.0. (Microsoft, USA). Results: The calculated PAFs, associated with tobacco use, for CVD mortality and morbidity was 13% and 9%, respectively. Economic burden of CVD associated with tobacco use in 2016 in the RF reached 335 billion rubles (4.7 billion €). The losses in the economy due to premature mortality (313.8 billion rubles) prevail in the structure of the main burden. Estimated direct costs were responsible up to 21 billion rubles. Conclusions: The significant economic burden associated with cardiovascular diseases provides an economic rationale for action to reduce the prevalence of lifestyle-related risk factors.

Economic burden of cardiovascular diseases before and after Iran\u2019s health transformation plan: evidence from a referral hospital of Iran

BackgroundDifferent countries have set different policies to control and decrease the costs of cardiovascular diseases (CVDs). Iran was aiming to reduce the economic burden of different disease by a recent reform from named as health transformation plan (HTP). This study aimed to examine the economic burden of CVDs before and after of HTP.MethodsThis cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran’s Ministry of Cooperatives, Labor, and Social Welfare, the central bank of Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials (IRR).ResultsTotal costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after (62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p = 0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2 to 36.7%. All hospitalization costs, except patients’ OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively.ConclusionEconomic burden of CVDs increased in the north-west of Iran after the HTP due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to unsustainable resources of the HTP. So, no results of this study can be attributed solely to the HTP. Therefore, more detailed studies should be carried out on the reasons for the significant increase in CVDs costs in the region.

PCV34 The Economic Burden of Cardiovascular Disease in Adults with Type 2 Diabetes in Israel

There is a lack of comprehensive cost information on cardiovascular disease (CVD) in people with type 2 diabetes (T2D). We aimed to characterise the short-term costs after a cardiovascular (CV) event compared with baseline costs, among adults with T2D in Israel. In this retrospective cohort study using the database of the Maccabi Healthcare Services, adults aged ≥21 years with T2D who experienced their first CV event (2013–2016) were identified by adjudicated enrolment in a CV registry (ischaemic heart disease, myocardial infarction including coronary revascularisation procedure, cerebrovascular accident, transient ischaemic attack, peripheral vascular disease or heart failure). Generalised linear models estimated healthcare resource utilisation in three periods after the CV event: immediate (1 month), acute (3 months) and short-term (12 months) for all patients, survivors of 1 and 3 months’ follow up, respectively, compared with resource utilisation in the corresponding baseline period (1, 3 or 12 months before the CV event). Direct medical costs (2018 United States dollars [USD]) were estimated using the State of Israel Ministry of Health price list. Overall, 5133 adults experienced a qualifying CV event with mean (standard deviation, SD) age of 67.4 (11.8) years; 43.9% had diabetes duration >10 years. Estimated immediate costs were USD 10,741 compared with USD 2820 at baseline (cost ratio [CR]: 3.81 [99% CI 3.51–4.13]), acute costs were USD 14,586 compared with USD 5202 at baseline (CR: 2.80 [99% CI 2.61–3.01]) and short-term costs were USD 23,847 compared with USD 11,123 at baseline (CR: 2.14 [99% CI 2.03–2.27]). In adults with T2D, direct costs were 3.8-, 2.8- and 2.1-fold higher after a CV event than at baseline over immediate, acute and short-term timescales, respectively. Based on these real-world data alongside evidence over longer timescales, the economic burden of CVD complicating T2D in Israel is substantial.

Estimation of the Economic Burden of Cardiovascular Diseases in Selected Hospitals of Yazd in 2018

Estimation of the Economic Burden of Cardiovascular Diseases in Selected Hospitals of Yazd in 2018

How Does Preterm Delivery Contribute to the Increased Burden of Cardiovascular Disease? Quantifying the Economic Impact of Cardiovascular Disease in Women with a History of Preterm Delivery.

Background: The association between preterm delivery (PTD) and maternal risk of cardiovascular disease (CVD) was demonstrated, but the economic burden of CVD in these women was unknown. Methods: A Markov microsimulation model, comprising no event, postacute coronary event (ACE, including acute myocardial infarction and unstable angina), poststroke, post-ACE and stroke, postheart failure, and death, was constructed to quantify the CVD burden in women with PTD from 2017 to 2066 using the Australian health care system perspective. Both first-ever and recurrent CVD events were accounted for in the model. Population with PTD histories was sourced from Australian Bureau of Statistics and costs of acute hospitalization and long-term management from government websites. Nonmonetary burden as years of life lost (YLL) was compared between women with and without PTD histories. Both dynamic (i.e., new cohort added every cycle) and static (i.e., population was stabilized) approaches were used to measure the CVD burden, with sensitivity analyses examining the robustness of results. Results: The dynamic model showed the total CVD burden caused by PTD as AUD11.4 billion for the next 50 years and the YLL as 0.34/capita, while the static model generated a cost of AUD4.5 billion and the YLL as 0.52/capita. Long-term management cost was the primary cost determinant (AUD9.4 billion and AUD3.7 billion, respectively) in the two models, with the results most sensitive to the discount rate and time horizon. Conclusions: Considering the substantial economic burden, recognizing PTD as a potential risk factor and encouraging women with PTD histories to participate in primary prevention programs would potentially curb the ever-increasing CVD burden.

Association of adherence to antiretroviral therapy with economic burden of cardiovascular disease in HIV-infected population.

There is a lack of studies that rigorously and systematically assess the economic burden of cardiovascular diseases (CVDs) related to the use of antiretroviral therapy (ART). We aimed to assess the association between adherence to ART and economic burden of CVDs in an HIV-infected population. Taiwan's National Health Insurance Research Database 2000-2011 was utilized for analyzing 18,071 HIV-infected patients free of CVDs before HIV diagnosis. The level of adherence to ART was measured by the medication possession ratio (MPR). Generalized estimating equations analysis was applied to estimate the cost impact of a variety of CVDs. All costs were presented in 2018 US dollars. The incidence of CVDs ranged from 0.17/1000 person-years (cardiogenic shock) to 2.60/1000 person-years (ischemic heart diseases (IHDs)). The mean annual medical cost for a base-case patient without CVDs was US$3000. Having cerebrovascular diseases, myocardial infarction, heart failure, arrhythmia, and IHDs increased annual costs by 41%, 33%, 30%, 16%, and 14%, respectively. The cost impact of incident CVDs in years with high adherence to ART (MPR ≥ 0.8) was significantly lower than that in years with low adherence (MPR < 0.1) (e.g. having cerebrovascular diseases in the high- versus low-adherence years increased annual costs by 21% versus 259%, respectively). The economic burden of incident CVDs in an HIV-infected population was compelling and varied by the extent of using ART. A reduced economic impact of CVDs was found in years when patients possessed a greater adherence to ART.

Economic burden of cardiovascular diseases from 2012 to 2017 based on French national claim database

Abstract Background The purpose of this study was to assess the economic burden of cardiovascular diseases (CVDs) in France by analysing the structure and the growth of expenditure attributed to these diseases between 2012 and 2017. Methods For each year, 11 CVDs were identified from SNDS data using algorithms based on long-term disease registry and hospitalization diagnoses, applied to the population of national health insurance general scheme beneficiaries. The individuals’ expenditure (26 different items) reimbursed for hospitalisations, ambulatory care and cash payments were included. A top-down method was used to attribute expenditure to each considered groups of diseases based on the average expenditure by disease calculated for individuals with only one disease. To analyse trends, we applied the same methodology from 2012 to 2017. Results In 2017, of the €140.1 billion reimbursed, €14.0 billion (10.0%) were attributed to the care of 4.0 million people with a CVD (7.0% of the population). Short-stay hospitalisations accounted for 33% of this total expenditure. This proportion was higher for acute CVD (coronary syndrome: 64%, stroke: 56%, heart failure: 65%, pulmonary embolism: 69%) but also for valvular heart disease (50.0%). Medications represented almost 13% of the expenditure attributed to all CVDs, and up to 25% for chronic coronary heart disease. Disability pension essentially concerned sequelae of stroke (12% of the expenditure attributed to this disease). Between 2012 and 2017, the total expenditure attributed to CVDs increased by 3.3% per year, mainly due to the annual mean increase of the number of patients over the period (+3.1%). Conclusions These results demonstrate the high economic burden of CVDs in France with a detailed analysis of expenditures and their main drivers. The developed tool will help decision makers to monitor the burden of these diseases but also to provide stake holders with a better understanding of trends and regulating actions. Key messages Economic burden of CVD in France is high: 10% of healthcare expenditure. Implementation of public health policy to prevent CVD and control risk factors must be a priority.