17 Economics CYAN MAGENTA YELLOW BLACK

17

The economics of CVD

Economic costs

The art of economics consists in looking

not merely at the immediate but at the
longer effects of any act or policy; it
consists in tracing the consequences of
that policy not merely for one group but
for all groups.
Henry Hazlitt, USA (18941993)

The costs of cardiovascular disease

are diverse: the cost to the
individual and to the family of
heath care and time off work; the
cost to government of health care;
and the cost to the country of lost
productivity.
We attempt here to quantify
some of these costs. However,
the value of a human life is
beyond our analysis.

United Kingdom

US
USA,
SA Aust
Australia
ustralia and
an Europ
ope

Global
obal co
costs of smok
mok
moking
He h care
Health
Heal
c costs associated
ciate with
smokin
king
ing-related
g
illnesses result
in a glo
glo
lobal net loss of US$200
billion
l on
on per year, with one tthird of
those
see losses occurring in
deve
eveloping countries.
ountries
untries
Estimated 1994.

2002 reports indicate

cate that up to
1
10%
of hhealth budgets
dgets are spent
on diabetes-related
diab
i
d illn
illnesses.

The direct cost of obesity to the National Health

Service is 0.5
0 5 billion [aboutt US
US$0.9
S$0 billion] per
year, while
hile th
the
he indirect cost to the UK
K eeconomy is
at least 22 billion [about US$3.5 bil
billio
billion].
Liam Donaldson,
son Chief Medical Off
Officer, 2003

physical exercise

stroke

diabetes

obesity

CVD

cholesterol

tobacco

More than
han
ann 4%
% of N
National Health
Hea Service
spending
ending
ng wa
wass on st
stroke
s o services
se
in 2000.

Global costs of heart

art
r disease
is
med
medication
Netherland
Ne
ether
t errla dss

USA
If
Iff jjust
jus 10%
% oof adults began walking
regularly,
ar Americans could save US$5.6
billion in costs related to heart disease.
President George W. Bush, 2002.

TThee aver
aveera
average
era totaal costs of
of ca
care pper
er patient
foorr six m
months
oonths following
f
g a stroke
st ooke were
estimated
es
est
ssti
tiimate
ima
mate
ttedd at 16 000
00
0 in
in 220
003
03.
03
Stroke
r kkee was estimated
ro
roke
mateed tto bee res
responsib
responsible
ssponsible
sponsibl
lee fforr
3% of total hhea
ealth
h care
c costs
c
in the
Netherlands
Nether
erlands in
er
n 199
994,
99
94, and 7%
7 of costs for
f th
the
he
populaaation age
gedd 775 andd ov
ove
over.r. Stroke
S
ran
nnked
k
secondd on the list
list of most costly
cosst y di
ddisease
diseases
ses
es for
the elddderly, afterr dementia,
dementia, andd th
these
the
he costs
are
re exxxpected to inc
increase
rease by 40%
% by
b 22015.

The direct costs of physical inactivity

accounted for an estimated US$24 billion
in health care costs in 1995.

Latin America
merica andd the Caribbean
Caribbeea
ea

Health problems related to obesity, such

ch
as heart disease and type 2 diabetes,
cost the USA an estimated
US$177 billion a year.

Permanent
manent disabilities resulting
ing
from diabetes cost
fr
ostt U
US$50 billion
illio
in 2000, while cos
cost
costs
sts as
sts
ass
associated
with insulin, hospitalization,
taliza
consultations and care
are ttotalle
ota led
US$10.6 billion.

Ch
Cholesterol
reducers were the top-sellingg
meeedic
ications in 2003, generating
ica
ic
US$13.
US
SS$
$13.9 billion in sales.

Global costs of diabetes

bet

The American Hear

art Association
estimates that stroke will cost a total of
US$53.6 billion in 2004.
20 Direct costs for
medical care and therapy
th
will average
US$33 billion andd indirect costs from
loost productivity will
w be US$20.6 billion.

Between 4% and 5% off health

budgets are spent on diabe
betesrelated illnesses.
WHO, 2003

In 200
2001,
20 thee National
Nat
Stroke Association
estima
stimaatted that
stim
t
the average cost per
patie
ieent
ent for
or the first 90 days after a
strook
oke wa
was
as US$15 000, although 10% of
cases
es co
cost more than US$35 000.

TThe number
ber of peo
people who
hoo die or aree disabled
by coronary
coron
nary heart disea
disease and sstrokee could be
halved with w
wider use oof a combination
mbina
of
drugs
ugss that
tha costs just USSS$1
S$14 a year
yea
year.
WHO, 2002
W

Singapore
Average hospital
sp
costs for stroke were
reported
orted in 2000 as US$5000 per
patient. Ward
pa
ar charges accounted for
38%, radiology
log 15%, doctors fees
10%, medications
10
catio 8%, therapy 7%.

TThe
Th
he cost
he
coosstt of
co
of risk
rriisk
sk factors
ffaaaccctto
tors
rs
Cum
C
Cu
um
um
mu
ulllaat
ulat
attive
ve Medicare
edic
ed
ica
caree co
costs
ts of
of treatm
ttrre
reaatttm
m
meennt of
of card
carddio
ca
iov
ovascular
asccuula
as
lar
ar
disease
di
dis
seeaase in
in people
peooppplle aged
pe
aagggeedd 665
5 years
yeaarss to
ye
to death
ddeea
eath, in the
he US
USA
2000
0
US$38 044 US$38 059
Ri k ffactors:
Risk
factors
t
US$
hhigh
gh blood
b ood pressure,
pressure
pr su e,
high
g cholesterol
cholesterol,
cho estero ,
ccigarette
igarettte smoking
smoking,
smooki
k ng
abno mal
abnormal
US$18 604
electrocardiograms,
electrocardiograms
ectrocard ogg ams,
US$11 711
a history
hi to y off
his
ddiabetes
abetes or
pprevious
evious heart
hear attacks
men

women
low risk
no heart disease risk factors

Lifetime
Lif
feti
tim
me costs
costs
t of co
coorrooon
nary hea
nary
eaarrtt ddiise
isseease
is
as e
as
Geermany
G
Germany
many
19996
1996
US$

US$4
S$4
S$
$48
b lllio
bi
ioon
n

US$2
US
S$
$26
b lllioon
bi
on

men
women
3 or more
risk factors

TTotal
ota direct costs
co ts
Including:
nc u ngg
pprimary
pr
ima y care
care,
cclinical
liini l care,
care
rehabilitation
e ab tat
ation
o

Tota
otal ind
nddirec
ect
c costs
cossttss
co
Lost
st product
prooddduuucctttivitty
pr
ty
caused
aused by
by:
sho
hortt-term
t-ttteerrm
tm and
andd
an
loonng-term
lo
ngg-te
teerrm
m dis
issabi
saabbbiliity
ity,
dea
eath

Average
Av
verage
g co
cost pe
pper casee: US$8
SS$
$882
2 000
000
00

Expenditure on cardiovasc

Chile

54

4.0

1.5

0.2

China

Egypt

Georgia

There
i
least s at
one
inter
venti
on
that
affor can be
ded e
ven
by lo
w-i
count ncome
ries.
1.4

Ghana

1.2

0.5

0.2

Indonesia Pakistan Sri Lanka

1.6

9.4%
1989

10.7%

10.8%

1993

1995

11.0%

9.8%

1991

rin
Aspi e least
h
g
ins t
rema nsive dru
y
e
r
exp econda
s
r
n.
fo
entio
prev

1997

Turkey

55