Economic burden of cardiovascular disease A literature review

ACKNOWLEDGEMENTS First of all, I would like to express my deepest gratefulness to my supervisor, MSc Doan Ngoc Thuy Tien, for supporting and guiding me with careful, patience during this thesis I am also grateful to all lecturers and staffs in the Institute of Preventive Medicine and Public Health and Hanoi Medical University for their suppons throughout the academic year Finally, I must express my verx profound gratitude to my family and to my friends for providing me with unfailing support and continuous encouragement throughout my years of study This accomplishment would not have been possible without them r-u -ÍM Qỉ ugc V Hl COMMITMENTS I declare that the thesis The economic burden of cardiovascular disease: A literature review" is my own work under the guidance of MSc Doan Ngoc Thuv l ien The Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi Vietnam, and that I acknowledged all results and quotations from the published or unpublished work of other people All data and results in this thesis were honest This thesis was compliant with ethical standards in research Hanoi 14u'May 6,2021 Author of thesis Vu Phuong Van r-u -ÍM CỊỈ ugc V Hl TABLE OF CONTENT ACKNOWLEDGEMENTS COMMITMENTS ABBREVIATIONS ABSTRACT INTRODUCTION CHAPTER LLITERATURE REVIEW 1.1 Literature review 1.2 Cardiovascular diseases 1.3 Epidemiology of CVD 1.4 Burden of cardiovascular 10 1.5 Cost of illness 11 1.5.1 Types of cost of illness 12 1.5.2 Approaches of cost of illness studies 14 1.5.3 Perspectives of cost of illness studies 16 1.6 Cost of illness by cardiovascular disease 17 1.6.1 Direct cost 17 16 Indirect cost 18 I7 Factors associated with cost of il Iness of cardiovascular disease .19 CHAPTER SUBJECTS AND RESEARCH METHOD 21 2.1 Study design 21 2.2 Eligible criteria 21 2.2.1 Inclusion criteria .21 2.2.2 Exclusion criteria 21 2.3 Search methods for identification of studies 22 2.4 Selection of studies 23 r-u -ÍM Qỉ ugc V Hl 2.5 Data extraction and management 23 2.6 Data synthesis 25 CHAPTER RESULTS 27 3.1 Results of the search .27 3.2 Study characteristics 28 3.3 Cost of illness anillysis .45 3.3.1 Direct cost 45 3.3.2 Indirect cost .48 3.4 Associated factor to the cost of ill ness caused by cardiovascular disease 50 CHAPTER DISCISSION 55 I Summarizing the cost of illness associated with cardiovascular disease 55 4.2 Reviewing some factors related to the cost of illness caused by cardiovascular disease 58 CONCLUSION .63 RECOMMENDATIONS 64 REFERENCES r-u -ÍM CỊỈ ugc V Hl LIST OF TABLES Table l.l Table 1.2 Table 1.3 Table 2.1 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 T11C number of deaths ca used by CVD in 2015 Examples of direct and indirect costs 14 Examples of costs included in cost of illness studies by perspectives .17 Search terms .22 List of included studies 30 Cost types & descriptions 36 Types of CVDs 43 Standardized direct cost of cardiovascular disease data 45 Standardized indirect cost of cardiovascular disease data 48 Associated factor to the cost of illness caused by cardiovascular disease .50 LIST OF FIGLRF.S Figure 1.1 Roles of cost of illness studies 12 Figure 2.1 PRISMA diagram of searching and screening process 25 Figure PRISMA diagram of searching and screening process 27 Figure 3.2 Proportion of studies divided by geographical region 28 Figure 3.3 Proportion of studies divided bv tile countries 29 r-u -ÍM Qỉ ugc V Hl ABBREVIATIONS Coronary artery disease CAD CVD CUD DVT GBD GDP HDL Cardiovascular disease Coronary heart disease Deep vein thrombosis Global burden of disease Gross domestic product High - density lipoprotein Higher - income countries HICs Health transformation plan HTP Iranian rials 1RR Low - density lipoprotein LDL Low - and middle - income countries LMICsMyocardial infarction MI Out-of-pocket OOP Peripheral arterial disease PAD Preferred reporting items for systematic reviews and metaanalyses Purchasing power parity PRISMA United states dollar PPP World health organization USD WHO ABSTRACT Background: Cardiovascular diseases are a major contributor to reduced quality of life, which caused economic consequences at multiple levels: individuals, households, economic agents, public institutions, government, and the society as a whole Especially in the low-and middle-income Asian countries, cardiovascular diseases began to spread out leading to an increasing number of prevalence and escalating healthcare spending Sufficient understanding of cost of illness is crucial in the formulation of healthcare policies as well as the rational allocation of healthcare resources in accordance with budget constraints Objectives: This literature review aims to summarize the cost of illness studies associated with cardiovascular diseases and review some factors related to the cost of illness caused by cardiovascular diseases, Methods: A literature search was perfonned on Google Scholar and PubMed Cost was summarized in terms of direct cost, indirect cost and each was converted to USD in 2020 for further comparison Cost components (including direct and indirect costs) were scrutinized to identify the key cost drivers and factors associated with these costs Results: A total of 19 studies were included in this review Most studies assessed costs from the patient perspective (n = 16), with the remainders being from the societal perspective, health service provider perspective Most studies were collected during the period from 2007 to 2021 chiefly included data from India (n - 7) Costs are mainly paid by the individual and family’s patients (Out-of-pocket payment) Indirect costs incurred by productivity losses due to morbidity and premature mortality The cost of cardiovascular diseases was found to be correlated with some risk factors, the nature of health facility, income quintiles and sonic other factors r-u -ÍM CỊỈ Hgc V Hl Conclusion: Direct costs for CVDs in each and evety countty are distinct Indirect cost tends to lie less calculated 111 research OOP in LMICs could result in financial catastrophe and increasing the economic burden for them Factors that influence on the costs of illness, includes some risk factors, residence location, income quintiles, the nature of health facility*, socio-economic status of patients, health transformation plan, comorbidity, discharge status Keywords: economic burden, costs of illness, cardiovascular diseases Asia, literature review r-u -ÍM CỊỈ ugc V Hl INTRODUCTION Cardiovascular diseases (CVDsX consisting of ischemic heart disease, stroke, heart failure, peripheral arterial disease, and a number of other cardiac and vascular conditions, constitute the leading cause of global mortality and are a major contributor to 12 reduced quality of life In 2017 It was estimated 17.8 million deaths worldwide, corresponding to 330 million years of life lost and another 35.6 million years lived with disability due to CVDs In Vietnam, CVDs caused about 31% of total deaths in 2016 corresponding to more than 170 000 ’ In addition to the large health burden, disability caused by CVDs has economic consequences at multiple levels: individual, household, economic agents, public institutions, government, and the society as a whole Whist the premature deaths from CVDs and other NCDs are considered as the consequences of reducing productivity, curtails economic growth and pose a significant social challenge in most countries This comes in the form of direct healthcare costs related to the prevention and treatment of CVDs and their risk factors Furthermore, there are several indirect costs related to CVDs These include the lost productivity of workers struck Other costs refer to the lost savings and assets that are foregone when families must face with catastrophic healthcare expenditures such as stroke rehabilitation or dialysis, when available Globally, It is estimated that from 2011 to 2025 the economic burden of NCDs will be USD trillion, with CVDs accounting for most of that expense 5*riiC American Heart Association has published recently an analysis report suggesting that that total direct (medical) and indirect (lost productivity) costs of CVDs the most costly of all chronic diseases, are supposed to rise from $555 billion III 2015 to $1.1 trillion in 2035.' Although age-standardized mortality from CVDs has decreased in man) regions of the world, the absolute number of deaths continues to increase, with the majority now occurring in the low and middle income countries (LMICs) The global number of deaths r-u -ÍM CỊỈ ugc V Hl 69 days On the other hand, patients who did not improve from CVD stayed on an average of days.'1 Limitations There were some limitations need to be taken into account in this study First, the results are dominated by studies from India No studies provided data for nussmg countries, so the findings cannot easily be generalized to the region as a whole Second, we only reviewed published literature and therefore some relevant data in gray literature (including no indexed regional journals) and English publications may have been Blissed, limiting the comprehensiveness of our review Further works must be performed in this area in other languages Third, with the results having lots of detail number regarding economic cost, the research would be of more value with the addition of the metaanalysis step Fourth, the intangible costs of pain and suffering was Ignored This category of costs IS often omitted because of the difficulty quantifying it in monetary terms accurately r-u -ÍM CỊỈ ugc V Hl 70 CONCLUSION Direct costs for CVDs in each and evety country are distinct because of the differences in data sources, approaches, and author’s perspectives As tire disease gets worse, patients need to be allocated more costs to palliative care and life maintenance instead of treatment as much as before, the time they spent in hospital increases, this leads to an increase in the cost of hospitalization for treatment Otherwise, indirect cost tends to be less calculated in research because the setting of the study IS usually the clinical setting with the researchers were also service providers, whose interest usually related to direct cost more Moreover OOP in LMICs could result in financial catastrophe and increase the economic burden for them when direct health care spending exceeded a household’s capacity to pay or household consumption Therefore Support policies to reduce the economic burden of CVDs are extremely necessary Factors that influence tire economic burden of cardiovascular disease are diverse, including: risk factors, residence location, income quintiles, the nature of health facility, socio-economic status of patients, health transformation plan, comorbidity Some studies revealed the medical costs were attributable to risk factors such as cigarette smoking and obesity This is because the risk factors could make condition of patients more serious and more severe so It could result in the longer period of time of treatment High - income people arewilling to pay more money on the healthcare cost (the cost of hospitalization) than low-income one It was showed that Expenditure of CVDs was higher when care was accessed 111 the private sector Similary to the nature of health facility when health trasfonnation plan took place, CVD patients had good access to medical care -ÍM Qỉ ugc V Hl 71 RECOM M EN DATIONS We suggest an increase in the budgetary allocation for non-communicable diseases, in order to expand and modernize the existing infrastructure for treatment ofCVDs We recommend formulating comprehensive strategies for prevention and control of CVDs These include strategies on tile reduction of risk factors, revamping the public health centers, accreditation of private health centers to provide cost-effective treatment and care, increasing awareness on healthy life Style through mass media, free health checkup and insurance coverage r-u -ÍM Qỉ ugc V Hl REFERENCES Roth GA, Abate D Abate KH et al Global, regional, and national agesex-specific mortality for 282 causes of death in 105 countries and territories 1980 2017: a systematic analysis for the Global Burden of Disease Study 2017 The Lancet 2018;392( 10159): 1736-1788 dot: 10.1016'S0140-6736( 18)32203-7 Kyu HI1, Abate D Abate KI I et al Global, regional, and national disabilityadjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HAI.F.) for 195 countries and territories, 1990- 2017: a systematic analysis for the Global Burden of Disease Study 2017 The Lancet 2018;392( 10159): 1859-1922 doi: 10.10 Í6/S0140- 6736(18)32335-3 Cardiovascular diseases (CVD) in Viet Nam htips:/Avww.\vho.ini/westempacific health-topics/cardiovascular- diseases Accessed April I 2021 Bloom DE, Cafiero E Jané-Llopis E Ct al The Global Economic Burden of Noncommunicable Diseases Program on tlie Global Demography Aging; 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