Disclosures: The authors report no relevant financial disclosures.
May 09, 2021
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Spending on CV health services increased by more than $100B from 1996 to 2016

Disclosures: The authors report no relevant financial disclosures.
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Health care spending on CVD increased to $320 billion in 2016, with treatment for hypertension, hyperlipidemia and atrial fibrillation/flutter being the primary drivers, according to data published in Circulation.

“U.S. adult cardiovascular spending increased substantially from 1996 through 2016, despite a slowdown in growth starting in the mid-2000s and a near-plateau in spending since 2010,” Maxwell Birger, MD, internist at the Columbia University Irving Medical Center and University of Washington in Seattle, and colleagues wrote. “The results of this detailed analysis of cardiovascular spending indicate that CVD costs increased substantially despite decreased utilization of services by health care providers, and increases in service price and intensity were a major reason. Efforts to control service price and intensity of health care services, as well as novel approaches to incentivize prevention and high-value care, may be needed to contain anticipated increases in spending due to population aging and growth and increasing cardiovascular mortality in the U.S.”

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For this analysis, researchers utilized data from the Institute for Health Metrics and Evaluation’s disease expenditure project to estimate U.S. adult CV spending patterns in 2016, change from 1996 to 2016 and factors associated with change over time.

The Institute for Health Metrics and Evaluation’s project uses data on insurance claims, ED visits, ambulatory care visits, in-patient and nursing care facility stays and drug prescriptions to estimate more than 85% of all U.S. health care spending, according to the study.

Researchers performed time trend and decomposition analyses to determine the association between changes in CV spending from 1996 to 2016 and contributions of epidemiology, service price, spending per unit of utilization (intensity) and population growth and aging.

Spending from 1996 to 2016

According to the study, adult CV spending increased from $212 billion in 1996 to $320 billion in 2016. During that period, the U.S. population increased by more than 52 million people and the median age increased from 33.2 years to 36.9 years.

From 1996 to 2016, public insurance accounted for the 54% of CV spending in the U.S., followed by private insurance (37%) and out-of-pocket spending (9%).

Researchers reported that the $80 billion spent on health services for ischemic heart disease and the $71 billion spent on hypertension accounted for the highest spending in 2016.

The biggest drivers of increased adult CV spending from 1996 to 2016 were:

  • treatment for hypertension, for which spending rose by $42 billion;
  • hyperlipidemia, for which spending rose by $18 billion; and
  • AF/flutter, for which spending rose by $16 billion.

Moreover, higher service price and intensity were independently associated with an $88 billion (51%) increase in adult CV spending from 1996 to 2016.

After adjustment for population growth and aging, changes in disease prevalence were associated with a $36 billion (37%) reduction in adult CV spending during the same period.

Trend ‘perpetuated’ by costly drugs

“It is difficult to project whether the trend of increased cardiovascular spending from 2013 to 2016 will continue into future years,” the researchers wrote. “The increase in spending may be perpetuated by the approval of costly cardiovascular drugs in recent years, such as sacubitril/valsartan (Entresto, Novartis) and PCSK9 inhibitors, which have seen increased utilization since 2016. Additionally, the recent approvals of tafamidis (Vyndamax and Vyndaqel; FoldRx/Pfizer) for transthyretin amyloid cardiomyopathy, which comes at a cost of $225,000 per year and is the most expensive cardiovascular drug ever approved, and of icosapent ethyl (Vascepa, Amarin), which costs around $4,800 per year, indicate that cardiovascular spending on pharmaceuticals may increase.”