Economic burden of cardiovascular disease a literature review

ACK NOW LODGEMENTS First of all I would like to express my deepest gratefulness to my supervisor MSc Doan Ngoe Thuy lien, for supporting and guiding me with careful, patience during this lhesis I am also grateful to all lecturers and staffs ill the Institute of Preventive Medicine and Public Health and Hanoi Medical University for their supports Uirouglioul the academic y ear Finally I must express my very profound gratitude to my fanulv and to my friends for providing me with unfailing support and continuous encouragement throughout my years of study I llis accomplishment would not have been possible without them COMMITMENTS I decline that the thesis “The economic burden of cardiovascular disease A literature review" is my own work under the guidance of MSc Doan Ngoc Thuy Tien - Tile 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Hanoi Medical University Hanoi, Vietnam, and that I acknowledged all results and quotations from the published or unpublished work of other people All data and lesults 111 this thesis were lionest This thesis was compliant with ethical standards in research Hanoi l4*May6,2021 Author of thesis Vu Phuong Van TABLE OF CONTEXT ACKNOWLEDGEMENTS COMMITMENTS ABBREVIATIONS ABSIRACT I INTRODUCTION C1IAPI ER l.u I ERA 11 RE RE\ IE w -.3 11 Liirratiue review 1.2 Cardiovascular diseases 1.3 Epidemiology ofCVD 1.4 Burden of cardiovascular 1.5 Cost of illness • •••••••••••••■•••••••••'•I •••••• 10 • • ••• • lilllt il Mill'tia (lllllllli II I I Types of cost of illness 12 Approaches of cost of illness studies 14 I S Perspectives of cost of illness studies 16 Cost of illness by cardiovascular disease 17 I 1.6 Direct cost 17 I Indirect cost IS I Factors associated with cost of illness of cardiovascular disease CHAPTER SUBJECTS AND RESEARCH METHOD 19 21 Study design 21 2 Eligible criteria ••••■ .M 2 Inclusion criteria 2 Exclusion criteria 21 21 Search methods for identification of studies 22 24 Selection of studies 23 «s> ■> Data extraction and management Data synthesis CHAPTER RESULTS 27 Results of the search 27 Study characteristics 28 3 Cost of illness analysis 45 3 Direct cost 3.3 Indirect cost 48 34 45 Associated factor tv the cost of illness caused by cardiovascular disease 50 CHAPTER DISCUSSION -.55 Summarizing the cost of illness associated with cardiovascular disease 55 Reviewing some factors related to the cost of illness caused by cardiovascular disease „.63 CONCLUSION^ 64 RF.COM ME N DAT1ONS REFERENCES «“ *4: LIST OF TABLES Tabic 1.1 I11C number of deaths caused by CVD ill 2015 Table 1.2 Examples of direct and indirect costs 14 Tabic 1.3 Examples of costs included 111 cost of illness studies by perspectives 17 Table 2.1 Search terms 22 Table 3.1 List of included studies Tabic 3.2 Cost types & descriptions 36 Table 3.3 Types of CVDs 43 Table 3.4 Standardized direct cost of cardiovascular disease data 45 Table 3.5 Standardized indirect cost of cardiovascular disease data 48 Table 3.6 Associated factor to the cost of illness caused by cardiovascular 30 disease 50 LIST OF FIGURES Figure I I Roles of cost of illness studies Figure 2.1 PRISMA diagram of searching and screening process 25 Figure 3.1 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 by the countries 29 12 ABBREVIATIONS CAD Coronary artery disease CVD Cardiovascular disease CHD Coronary heart disease DVT Deep vein thrombosis GRD Global burden of disease GDP Gross domestic producl HDL Hitih - density lipoprotein HICs Higher - income countries HTP Health transformation plan IRR Iranian rials LDL Low - density lipoprotein LMICs Low - and middle - income countries Ml Myocardial infarction OOP Out-of-pocket PAD Peripheral arterial disease PRISMA Preferred reporting Items for systematic reviews and meta­ analyses PPP Purchasing power parity USD United states dollar WHO World health organization TWM*M«K> *4: 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 lhe society as a whole Especially in the low-and middle-income Asian countries, cardiovascular diseases began to spread out I coding to an increasing number of prevalence and escalating liealllicarc spending Sufficient understanding of cost of illness IS crucial 111 the fonnulation 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 llic cost of illness caused by cardiovascular diseases Methods: A literature search was performed on Google Scholar and PubMed Cost was summarized in terms of direct cost, indirect cost and each was converted to USD tn 2020 for further comparison Cosi 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 Illis review Most studies assessed costs from the patient perspective (n ■ 16 k with the remainders being from the societal perspective, health service provider perspective Xlost studies were collected during the period from 2007 IO 2021 chiefly included data from India tn - 7) Costs arc mainly paid by the individual and family’s patients (Out-of-pocket payment) Indirect costs inclined by productivity losses due to morbidity and premature mortality The cost of cardiovascular «s> ■> diseases was found lo Ik correlated with some nsk factors, the nature of health facility income quintiles and some Ollier factors Conclusion: Direct costs for CVDs in each and every country are distinct Indirect cost tends to be less calculated in research OOP III LMICs could result in financial catastrophe and increasing die economic burden for them Factors that influence on the costs of illness, includes some risk factors, residence location, income quintiles, tile namre 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 INTRODUCTION Cardiovascular diseases (UVDs) 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 reduced quality of life ■ In 2017 it was estimated 17 million deaths worldwide corresponding to 330 million years of life lost and another 35.6 million years lived with disability due to CVDs 111 Vietnam CVDs caused about 31% of total deaths in 2016 corresponding to more than 170 (XX) •' In addition to the large health burden, disability caused by CVDs has economic consequences al multiple levels: individual, household, economic agents, public institutions, government, and the society as a whole Whist the premature deaths from CVDs and other NCDs arc 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 Ihat 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 ofNCDs will be USD trillion, with CVDs accounting for most of that expense 'The American Heart Association lias 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 m 2015 to $1 I trillion in 2035" 62 Willie patients who unproved from CVD after admission IO hospital stayed on average 4.6 days and patients who completely recovered from CVD stayed on average 05 days On the other hand, patients who did not improve from CVD stayed on an average or3 days Limitations There were some limitations nerd to be taken into account in this study First, lhe results are dominated by studies from India No studies provided data for trussing 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 missed, limiting the comprehensiveness of our review Further worts 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 meta- analysis step Fourth, the intangible costs of pain and suffering was Ignored This category of costs IS often omitted because of the difficulty quantify mg it in monetary terms accurately 63 CONCLUSION Direct costs for CVDs in each and every country are disiinci because of the differences in data sources approaches, and author's perspectives As the disease gets worse, patients need IO 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 tire study IS usually the clinical setting with the researchers were also sen ice 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 IO pay or household consumption, therefore, support policies IO reduce the economic burden ofCVDs are extremely necessary Factors that influence the 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 Sonic 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 111 the longer period of time of treatment High * income people arew tiling to pay more money on tile healthcare cost (rite cost of hospitalization) than low-income one It w» showed that Expenditure of CVDs was higher when care was accessed in the private sector Similary 10 the nature of health facility when health uaifomiaiion plan took place CVD petients had good access to medical care 64 RECOMMENDATIONS We suggest an increase in tlx: budgetary allocation lor non-communicable diseases, in order to expand and modernize the existing infrastructure for treatment of CVDs We recommend formulating comprehensive strategies for prevention and control of CVDs These include strategies on the reduction of risk factors, revamping tlx public health centers, accreditation of pmatc health centers to provide cost-effective treatment and care, increasing awareness on healthy life style through mass media, free health checkup and insurance coverage REFERENCES Roth GA, Abate D Abate KH el al Global, regional, and national age- sex-specific mortality for 282 causes of death in |95 countries and territories 1980 2017: a systematic analysis for the Global Durden of Disease Study 2017 Dre lancet 2OI8;392i.10159):1736-1788 del 10 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