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European Union's €169 billion bill for cardiovascular disease

Risk Factors and Prevention

Cardiovascular disease cost the European Union's economy €169 billion in 2003, according to a study published on-line in Europe's leading cardiology journal, European Heart Journal [1].

CVD cost every man, woman and child in the EU €230 in healthcare costs [2], took up 12% of all the healthcare expenditure, accounted for 126 million hospital bed days, 268.5 million working days lost and severely hampered the daily activities of 4.4 million people – one in every 100 EU citizens.

The two million deaths from cardiovascular disease (CVD) in 2003 represented €24.4 billion of the total bill and a loss of 2.18 million working years.

The study, from a team at the Health Economics Research Centre, Department of Public Health, University of Oxford, England, is the first to assess the economic impact of CVD in the 25 EU member states.

Lead author José Leal, a research officer in the department, said: "CVD, with its main components of coronary heart disease and cerebrovascular disease, is the principal source of mortality and morbidity in the EU, yet until now, there has been no systematic cost-of-illness study to evaluate its economic burden on the EU. The objective of this study is to help policy makers assess the impact of their policies and set priorities for research spending. It also highlights the need for comparable and accurate information on CVD prevalence, mortality and healthcare resources within all EU countries as well as the EU as a whole."

The analysis covered total healthcare estimates – primary, outpatient, emergency and in-patient care and medication – plus the costs of unpaid care and lost earnings due to illness and premature death.

In-patient care accounted for €60 billion (57%) of the healthcare costs. Pharmaceutical expenditure at €28.4 billion represented 27%, with primary, outpatient and emergency care absorbing 16%.

A breakdown of the contributions that the various types of CVD made to the total costs showed that coronary heart disease and cerebrovascular disease accounted for nearly two thirds of all CVD deaths and 47% of costs. So, other CVDs, such as high blood pressure or other forms of heart disease, contributed an even higher proportion to the economic burden.

The report also revealed the hidden costs of informal care for the first time – an estimated €29 billion with 2.98 million CVD sufferers receiving 2.95 billion hours help from unpaid carers.

Around 1.375 million people were involved in providing unpaid care to patients with coronary heart disease or cerebrovascular disease alone.

The study identified considerable variations between countries in the overall burden of CVD and the percentage CVD took up of each country's total healthcare expenditure.
For example, Germany and the UK represented over half of all EU CVD costs. Their expenditure took up 15% and 17.1% respectively of the two countries' healthcare budgets, with the UK's CVD proportion of total health spending being the highest of all EU countries. Other countries spending over 15% of their healthcare budget on CVD were Slovakia, Estonia, Lithuania, Czech Republic and Poland. By contrast, the lowest proportion of the budget spent on CVD was by Malta (2%) and Ireland (4.4%).

The report also showed a difference in the average estimated per capita spending between the EU at €230 per head and the USA at about €715 per head (around €485 more per US citizen allowing for adjustment for price differences between the two economies).

"We must emphasise that the aim of our study was not to judge whether countries were spending too much or too little relative to others," said Mr Leal. "Establishing the cost of an illness doesn't permit us to say if a country is spending too much or too little. The real use is that it will allow comparisons to be made within countries, and the EU as a whole, of the burden imposed by different diseases. This should help potentially to prioritise scarce resources."

There have been few cost-of-illness studies evaluating the impact of other diseases in the enlarged EU, although estimates for diabetes range from €32 to €61 billion.
Co-author and research officer, Ramon Luengo-Fernandez, said: "The €169 billion cost of CVD to the EU is more than any other published estimates for other diseases, and if anything, is likely to be an under-estimate. Our figures are for 2003: taking current trends in medical price and wage inflation into account, we estimate the costs will have risen to around €181 billion in 2005. International studies as big as this one do require substantial research input and funding, but this type of analysis should be performed regularly at five to eight-year intervals to measure the impact of policy decisions or developments in healthcare. It has, to give a concrete example, the potential for monitoring the contributions made to reducing the burden of CVD of interventions by policies such as legislation to curb smoking."


1] Economic burden of cardiovascular diseases in the enlarged European Union. European Heart Journal. doi:10.1093/eurheartj/ehi733.

[2] Healthcare costs: includes primary, in-patient, out-patient and emergency care, and medication. It does not include informal care costs and productivity loss, which are included in the overall costs of €169 billion.

Notes to editor

The European Heart Journal is an official journal of the European Society of Cardiology. Please acknowledge the journal as a source in any articles. Paper available on request.