Real cost of heart attacks and strokes: Double the direct medical expense
Sophia Antipolis, 7 April 2019: The full financial cost of a heart attack or stroke is twice as much as the medical costs when lost work time for patients and caregivers is included.
That’s the finding of research published today, World Health Day, in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1 The study concludes that victims of heart attack and stroke who return to work are 25% less productive in their first year back.
In the year after the event, heart patients lost 59 workdays and caregivers lost 11 workdays, for an average cost of €13,953, and ranging from €6,641 to €23,160 depending on the country. After stroke, 56 workdays were lost by patients and 12 by caregivers, for an average €13,773, ranging from €10,469 to €20,215.
Study author Professor Kornelia Kotseva, of Imperial College London, UK, said: “Patients in our study returned to work, meaning their events were relatively mild. Some still had to change jobs or careers, or work less, and caregivers lost around 5% of work time. Not included in our study are those with more severe events who quit work altogether and presumably need even more help from family and friends.”
The study enrolled 394 patients from seven European countries – 196 with acute coronary syndrome (86% heart attack, 14% unstable chest pain) and 198 with stroke – who returned to work 3 to12 months after the event. Patients completed a questionnaire2,3 during a visit to a cardiologist, neurologist, or stroke physician. Hours lost were valued according to country labour costs in 2018. The average age of patients was 53 years.
According to published estimates for Europe, the direct medical costs of acute coronary syndrome are €1,547 to €18,642, and €5,575 to €31,274 for stroke.4 “This is the metric commonly used to estimate the costs of medical conditions while indirect costs from productivity loss are often not taken into account by clinicians, payers or policymakers,” said Professor Kotseva. “Taken together, the actual burden on society is more than twice the amount previously reported.”
Reasons for lost productivity were consistent across countries: 61% was the initial hospitalisation and sick leave after discharge; 23-29% was absence from work after the initial sick leave (for medical appointments and shorter sick leave); 9-16% was being unable to work at full capacity because of feeling unwell.
Even more workdays were lost in the first year after the event for patients with previous events or established cardiovascular disease. When adding days lost by patients and caregivers together, this was 80 for acute coronary syndrome and 73 for stroke, costing €16,061 and €14,942, respectively.
In the study, 27% of heart patients and 20% of stroke patients were obese, while 40% of heart patients and 27% of stroke patients were current smokers.
“Productivity loss associated with cardiovascular events is substantial and goes beyond the patient,” said Professor Kotseva. “Preventing acute coronary syndrome and stroke is the key to improving health and longevity and avoiding the myriad of costs that come with such an event. The true tragedy is that so many heart attacks and strokes could be averted by not smoking, being physically active, eating healthily, and controlling blood pressure and cholesterol. The evidence could not be stronger.”
Authors: ESC Press Office
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Sources of funding: This study was funded by Amgen (Europe) GmbH.
Disclosures: Please see the paper for disclosures of all authors.
1Kotseva K, Gerlier L, Sidelnikov E, et al. Patient and caregiver productivity loss and indirect costs associated with cardiovascular events in Europe. Eur J Prev Cardiol. 2019.
2Patients filled in the Productivity Cost Questionnaire (iPCQ) designed by the Institute for Medical Technology Assessment at Erasmus University in Rotterdam and validated to collect productivity loss data. It included questions about the amount of help needed from caregivers.
3Bouwmans C, Krol M, Severens H, et al. The iMTA Productivity Cost Questionnaire: A Standardized Instrument for Measuring and Valuing Health-Related Productivity Losses. Value Health. 2015;18:753-758. doi:10.1016/j.jval.2015.05.009.
4Nicholson G, Gandra S, Halbert R, et al. Patient-level costs of major cardiovascular conditions: A review of the international literature. Clinicoecon Outcomes Res. 2016;8:495-506. doi:10.2147/CEOR.S89331.
About the European Society of Cardiology
The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.
About the European Journal of Preventive Cardiology
The European Journal of Preventive Cardiology is the world’s leading preventive cardiology journal, playing a pivotal role in reducing the global burden of cardiovascular disease.