Heart disease hurting economy

Heart disease in Europe claims over two million lives every year, and cost the European Union 192 million euros (285 million dollars) in 2006, a group of health organisations announced.

The statistical study, by the European Society of Cardiology and the European Heart Network, also shows huge differences across Europe in death rates due to coronary artery disease and strokes, the two main types of heart disease. Several countries in eastern and northern Europe - notably Romania, Bulgaria, Latvia and Estonia - have mortality rates five to seven times higher than western European nations, especially France, Portugal and Switzerland, the study showed.

The European study showed that of the 192-billion-euro cost in 2006 of CVD, 57 percent was directly linked to health care, while 21 percent was attributed to productivity loss, and 22 percent to the cost of informal care provided by relatives and friends. The financial burden of heart disease resulted in a per capita cost of 391 euros (581 dollars).

Similar staggering figures for South Africa were released last year by the Medical Research Council.

Cost of CVD in SA
According to the Challenge Complacency Report that was released by the Medical Research Council in July last year; in 1991, the cost of coronary vascular disease (CVD) was between R4.135 and R5.035 billion, which did not include the costs of rehabilitation and follow-up.

"This expenditure reflects 2%-3% of gross domestic product (GDP) or roughly 25% of all healthcare expenditure," the report stated.

It further revealed that South Africa is already losing more people in the workforce age group (35-64 years) because of CVD compared to countries such as the USA and Portugal and these premature deaths have a major economic impact on the economy of the country.

Alarmingly, it projected that cardiovascular deaths will increase by 41% in this age group between 2000 and 2030. Estimates are that in 2000, the cost of cardiovascular disability payments in South Africa equalled US$ 70 million.

"The drug costs for CVD and its risk factors vary widely among different countries. These costs are usually much less if generic medications of commonly used drugs are available," the report stated, adding that: "The most cost-effective interventions to reduce CVD are those which target the population as a whole and include education through the mass media to promote a healthy diet, regular physical activity, along with legislation targeting tobacco control and the reduction of salt in commercial food products.

Recommendations for treatment
It is recommended that when treating individual patients, the most cost-effective approach is the absolute risk approach where the total cardiovascular risk is determined by considering the impact of all the risk factors present in a patient.

"There is good evidence that it is cost-effective to combine a number of effective medications into one single tablet. This idea of a 'polypill' containing low doses of multiple drugs has generated much interest, with proponents arguing that, given the high prevalence of CVD risk factors and the effectiveness of pharmacologic interventions, such a drug combination would reduce CVD mortality by 88%," claimed the report.

It concluded that the “polypill” would be particularly cost-effective in developing countries as patients take single-pill combinations more religiously than several tablets at a time. This approach would also reduce the supply and transport costs.

High number of CVD deaths in SA
According to the MRC report, between 1997 and 2004, 195 people died per day because of some form of heart and blood vessel disease in South Africa. It also showed that:

  • About 33 people die per day because of a heart attack, while about 60 die per day because of stroke.
  • For every woman that dies of a heart attack, two men die.
  • About 37 people die per day because of heart failure.
  • Despite the high death rates caused by Aids in South Africa, actuarial projections suggest that the rate of chronic diseases, including heart disease, is also going to increase by 2010. The models suggest that chronic disease death will increase from 565 deaths per day in 2000 to 666 deaths per day in 2010.
  • More than half the deaths caused by chronic diseases, including heart disease, occur before the age of 65 years. These are premature deaths which affect the workforce and have a major impact on the economy of the country.
  • Premature deaths caused by CVD in people of working age (35-64 years) are expected to increase by 41% between 2000 and 2030. The negative economic impact of this will be enormous.
  • The highest death rates for heart and blood vessel diseases in South Africa are found amongst Indian South Africans, followed by coloured people, while the white people and black people have the lowest rates.
  • Although the white people and black African people have similar rates for these diseases, their patterns differ considerably. White people mainly reflect a pattern of death caused by heart attacks, while the black African people reflect that of death caused by stroke, and diseases of the heart muscle and high blood pressure.
  • Source: Sapa and the Challenge Complacency Report from the Medical Research Council.

    - February 2008

    Read more:
    New heart guidelines for women
    Heart disease: shock facts

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