Managed Care Outlook

The seesaw of CVD: Deaths down, costs up

Cardiovascular disease (CVD) is less of a killer than it used to be in the United States, but the costs associated with the disease are expected to double by 2030, according to the American Heart Association’s 2017 Heart Disease and Stroke Statistics Update.

In 2014, the age-standardized death rate attributable to CVD was 220.8 per 100,000, a decrease of almost 15% from 2007, according to the AHA’s report. Some of the decline can be chalked up to prevention, and the AHA predicts that coronary heart disease deaths will decline by 30% between 2010 and 2020 because of improvement in “cardiovascular health metrics” (avoidance of smoking, more physical activity, and so on).

Projected direct costs of total cardiovascular disease by type of cost

(2010 dollars in billions)

But AHA calculations show that this less-deadly era of CVD is going to be a more costly one, with direct medical costs of CVD more than doubling by 2030 to $918 billion from $396 billion in 2012.

The 10 leading diagnoses for direct health expenditures

United States, average annual 2012 to 2013 (in billions of dollars)

That spending on CVD medical care is expected to approach a trillion dollars is a reflection, in part, of how common the disease is. By 2030, an astounding 43.9% of Americans will have some form of CVD, according to the AHA’s update. CVD will have company: The youngest baby boomers turn 66 in 2030, so most, if not all, age-related conditions are likely to become more common in the years ahead.

Obviously, the cost of treating and managing CVD is another factor in the northward slope of the trend lines. Many CVD treatments involve fairly complicated surgery and relatively long stays in the hospitals, so hospital costs are a major factor in CVD direct medical costs. The AHA reports, for example, that the average hospital charge for coronary bypass was just over $160,000 in 2013. That is about what a four-year college costs, and the average hospital stay is just 6.2 days. Granted, hospital charges do not reliably show what actually gets paid for, but they are a rough indicator of relative expense.

Average hospital charges for various cardiovascular procedures

2013 National Healthcare Cost and Utilization Project (HCUP) Statistics

The number of bypasses being performed is decreasing. Not so the number of heart transplants (2,804 of them were performed in 2015), and the average hospital charge for a heart transplant in 2013 was a little more than $750,000.

Estimated direct and indirect costs for total cardiovascular disease

United States, average annual 2012 to 2013 (in billions of dollars)

Source for all charts: Heart Disease and Stroke Statistics–2017 Update, Circulation, Jan. 25, 2017

There seems to be no relief in sight from high hospital costs. The AHA’s crystal ball shows them going up faster than other CVD-related costs (drug, physician, nursing home, home-health costs).