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Price tag on cardiovascular disease in Europe higher than entire EU budget


Amsterdam, Netherlands – 26 Aug 2023: Cardiovascular disease (CVD) cost the EU an estimated €282 billion in 2021, according to late breaking research presented at ESC Congress 2023.1 Health and long-term care accounted for €155 billion (55%) of these costs, equalling 11% of EU health expenditure. The analysis was a collaborative effort by the European Society of Cardiology (ESC) and the University of Oxford, UK.

Study author Dr. Ramon Luengo-Fernandez of the University of Oxford said: “CVD had a significant impact on the EU27 economy, costing a total of €282 billion in 2021. That’s equivalent to 2% of Europe’s GDP and is significantly more than the entire EU budget2 itself, used to fund research, agriculture, infrastructure and energy across the Union.”

This was the most comprehensive and up-to-date analysis of the economic costs of CVD to society in the EU since 2006. It is the first study to use Europe-wide patient registries and surveys rather than relying on assumptions and, unlike previous reports, includes the costs of long-term social care. The current analysis provides estimates of the societal economic costs of CVD for the 27 members states of the EU in 2021, including 1) health and social care; 2) informal care; and 3) productivity losses. The breakdown includes:3

  • €130 billion for healthcare (46%)
  • €25 billion for social care (9%)
  • €79 billion for informal care (28%)
  • €15 billion in productivity losses due to illness/disability (5%)
  • €32 billion in productivity losses due to premature death (12%).

The total cost equated to €630 per EU citizen, ranging from €381 in Cyprus to €903 in Germany.4

CVD cost health and social care systems approximately €155 billion in 2021, accounting for 11% of total healthcare expenditure. There was wide variation between countries in the proportion of healthcare budgets spent on CVD, from 6% in Denmark to 19% in Hungary. Healthcare included primary care, emergency care, hospital care, outpatient care and medications, while social care included long-term institutionalised care, and care at home. The main contributor was hospital care, which cost €79 billion, representing 51% of CVD-related care costs. CVD medications accounted for €31 billion (20%) of care costs, followed by residential nursing care homes at €15 billion (9%).

Informal care costs included the work or leisure time, valued in monetary terms, that relatives and friends gave up to provide unpaid care. Relatives and friends provided 7.5 billion hours of unpaid care for patients with CVD, amounting to €79 billion across the EU.

Productivity losses included lost earnings due to illness/disability (early retirement/absenteeism) or premature death. In 2021, 256 million working-days were lost in the EU because of CVD illness/disability, at a cost of €15 billion. That same year, 1.7 million people died due to CVD across the EU, representing 1.3 million working-years lost, and generating productivity losses of €32 billion.

ESC Board member and study author Professor Victor Aboyans of Limoges University, France said: "This study underscores the urgent need to act collectively on the European scale to better combat the cardiovascular risk of European citizens, in particular through regulations for better cardiovascular prevention and investment in research. By choosing not to invest in cardiovascular disease we are simply deferring the cost. These data force us to ask the question: do we invest in cardiovascular health today or be forced to pay more at a later stage?”

Professor Panos Vardas, chief strategy officer of the European Heart Agency, the ESC’s office in Brussels, said: “Today’s presentation provides a clear understanding of the overall economic burden of cardiovascular disease across different EU countries, offering the opportunity to draw valuable conclusions that are useful for those responsible for designing healthcare plans. It is evident that there is significant fragmentation among EU countries in terms of cardiovascular disease healthcare expenditures. This necessitates a re-evaluation by the EU as a whole, and the 27 EU countries individually, to better address the outstanding needs and invest more effectively in supporting those suffering from cardiovascular disease.”



Notes to editor

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Funding: This work was supported by an unrestricted grant from the European Society of Cardiology (ESC).


Disclosures: JL, AG and RLF report research grants from the ESC. ADT has stock in two start-up companies, receiving no income from these investments. AT has a consultancy agreement with ESC. APM reports payments from Astra Zeneca and Bayer for participation in study committees in areas outside the present work. PV reports consulting fees from Servier International, Hygeia Hospital Group and ESC. RH and ML report no disclosures.


References and notes

1Economic burden of CVD in the EU will be discussed during:

2EU budget:,amount%20to%20%E2%82%AC168.6%20billion.Leal J, Luengo-

3Numbers total €281 (not €282) billion due to rounding.  In particular, CVD cost the EU €281,537 million in 2021.

4Per EU country: CVD care costs as % of total health care expenditure and CVD costs per capita adjusted for price differentials.


About ESC Congress 2023

It is the world’s largest gathering of cardiovascular professionals, disseminating ground-breaking science both onsite in Amsterdam and online – from 25 to 28 August. Explore the scientific programme. More information is available from the ESC Press Office at


About the European Society of Cardiology

The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.