"Cardiovascular diseases (CVDs), disorders of the heart and blood vessels, are the leading global cause of death annually," says a published by The Economist Intelligence Unit (The EIU) and EIU Healthcare, its healthcare subsidiary. Commissioned by Amgen, an American biopharmaceutical company, Protecting the heart: Preventing cardiovascular disease in Asia further explains CVDs "levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs."
The report provides a study of the economic impact of CVD risk factors on the following Asian markets: Australia, China, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand. Below are its key takeaways:
"The rising incidence of CVD poses a substantial challenge to Asia-Pacific markets. The rising incidence and expected treatment costs of CVDs challenge the sustainability of many healthcare financing models in the region. Early retirement and functional disability from rising CVD incidence also erode the tax base and put pressure on social service budgets. This can lead to fiscal constraints that have a regressive impact on citizens. Reducing risk factor incidence, which could reduce and even prevent CVDs, is a more preferable strategy.
"The four main modifiable cardiovascular risk factors pose a communications challenge for governments and health agencies. Because the effects of the four risk factors on cardiovascular health—smoking, hypertension, obesity and high cholesterol— can accumulate over many years, individuals have little to no knowledge that they have increased their risk for CVD until symptoms occur. This makes preventing these risk factors all the more challenging.
"Hypertension is the risk factor that contributes the highest cost. Hypertension is exerting the greatest population attributable cost across the eight markets with an estimated total of US$18bn annually, according to Economist Intelligence Unit estimates. Across the other estimated annual risk factor costs, high cholesterol contributes US$15bn, smoking US$11bn, and obesity $8bn.
"The costs of CVDs are not fixed. Greater awareness and policymaker attention can substantially reduce CVD costs as many obstacles and corresponding solutions have been identified as effective. For example, the World Heart Federation provides a number of roadmaps to manage CVD risks brought on by hypertension, high cholesterol and smoking. For the two “silent” risk factors, the pathways are similar: improve patient and physician awareness of key risk factors, increase access to diagnostic testing, empower patients with knowledge, and provide professional support and affordable drug access to manage their risks.
"Policy options for primary prevention include choice 'nudges.' Policy options for primary prevention of all risk factors include 'nudges' to positively influence dietary choices, such as improved food labeling or partnerships with companies to encourage food reformulation to remove unhealthy ingredients. Investment in green spaces in urban areas and subsidized access to health facilities can also encourage physical activity.
"Effective secondary prevention can also significantly affect costs and outcomes. The recurrence rates for people suffering from a CVD event are high. For instance, in Australia, the risk of a subsequent stroke is 43% in the ten years following the first event, and the mortality rates for known sufferers of CVDs are substantially higher than those not at high risk. Across the span of a first CVD event and one’s death, the cost for disease management and the treatment of secondary events can be significant. Prioritizing at-risk groups can also drive positive impacts on CVD cost management."
Based on my experience, I agree that "[t]he Asia-Pacifc's CVD burden sits within the broader context of a rise in NCDs (noncommunicable diseases), due partly to ageing populations and partly to economic transition. It is a threat to the health and financial security of citizens and a burden on the public finances. Efforts to increase access to healthcare over recent decades will be undermined if cost-cutting measures are required to balance the books."
The report encouragingly concludes that "many risk factors for CVDs are modifiable through primary and secondary preventions, across behavior, lifestyle and medical domains. Looking forward, a powerful CVD action plan is one that targets multiple points along the 'continuum' from primary prevention to cost-effective treatment methods and secondary prevention. Innovation in service delivery and greater leveraging of data, digital technology and wearable devices can also help optimize CVD detection and management in cost-effective ways."
What solutions are you seeing that are reducing the incidence of CVDs?