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Late-Breaking Science: New data highlight the huge economic burden of CVD in Europe

27 Aug 2023

A collaborative initiative between the ESC and the University of Oxford provides unique insights into the current economic burden of CVD across EU countries. 

It is well known that CVD has a significant economic impact on health and social care systems, as well as incurring considerable indirect costs related to reduced productivity and economic output of patients and their carers; however, previous pan-European estimates of this burden are outdated. Furthermore, earlier studies have relied heavily on numerous assumptions rather than obtaining data from patient registries and surveys.

Co-Principal Investigator of the Oxford-ESC Burden of Cardiovascular Disease project, Doctor Ramon Luengo-Fernandez (University of Oxford - Oxford, UK) says, “CVD is not just a health issue – there is a significant and undeniable lack of up-to-date international, systematic and comparative evidence on the economic burden of CVD in Europe at present.” Initiated in 2020, with Co-Principal Investigator Associate Professor Jose Leal (University of Oxford - Oxford, UK), the Oxford-ESC Burden of Cardiovascular Disease project aims to fill this gap with new data that have been rigorously collected and validated according to the highest academic standards and methodologies.

Moderated ePosters discussing data from this collaborative project were presented on Friday. Doctor Inna Thalmann (University of Oxford - Oxford, UK) described an analysis of resource use associated with experiencing heart disease and/or cerebrovascular disease for the first time over an average follow­up of 10 years across 28 European countries and Israel. An increase in health care resource use was observed in the year of the CVD event relative to previous years and costs increased over time after the event. In addition, there was considerable variation, with lower health and informal care costs in the years after heart disease incurred in participants in Scandinavia compared with Central Europe.

Doctor Marjan Walli-Attaei (University of Oxford - Oxford, UK) described an analysis of healthcare costs associated with atrial fibrillation-related complications across 27 European and Central Asian countries. Although disease complications were found to be costly in all countries, notable differences were observed across countries driven by fewer investigations, clinic visits and emergency room admissions.

Dr. Luengo-Fernandez presented data on the overall economic burden of CVD at a Late-Breaking Science session yesterday. In the analysis, CVD-related costs (ICD-­10 I00­-I99) were estimated for 27 EU countries for 2021. Country-specific resource use was approximated using aggregate data on morbidity, mortality, and health, social and informal care. Overall resource use was then apportioned to CVD using patient-level data based on country-specific responses from 140,000 participants recruited to the Survey of Health, Ageing and Retirement in Europe. Resource use was valued using country-specific unit costs, obtained from numerous sources, namely payments and tariffs for CVD-specific admissions and procedures, reimbursement lists, previously published studies, national expenditure estimates, and national data on earnings.

In 2021, CVD was estimated to cost the EU €282 billion.

Around €155 billion – 55% of the total – was attributed to direct health and long-term care costs, equalling 11% of total EU-health expenditure. Productivity losses associated with early mortality and incapacity for work were estimated at €32 billion (12% of the total) and €15 billion (5%), respectively, and the cost of unpaid care by friends/relatives was estimated at €79 billion (28%).

To allow for meaningful comparison between countries, cost estimates were also adjusted for price differentials and estimated on a per-capita basis. In total, CVD cost €630 per person in the EU, with wide variation such that costs ranged from €381 in Cyprus to €903 in Germany. Direct health and long-­term social care costs were €347 per EU citizen and ranged from €154 per person in Croatia to €486 in Germany. The disease types associated with the greatest proportion of overall CVD costs were coronary heart disease (CHD) and cerebrovascular diseases, which accounted for 28% (€77 billion) and 27% (€76 billion), respectively. As a proportion of overall CVD costs, CHD was lowest in Luxembourg (20%, €82 million) and highest in Lithuania (44%, €627 million).

“These findings highlight the considerable impact of CVD on all aspects of the economy and society,” notes Dr. Luengo-Fernandez. “This robust evidence can be presented to decision makers at pan-European and national levels to reinforce the need for CV health plans and sustained public health policies to reduce the burden of CVD. In addition, these data can be used to inform actions to reduce variations in care, to improve access to care and as a way to target research expenditure.” The project will now move on to estimate the health care costs associated with CVD in the remaining countries of the ESC.