P900Projections of heart failure costs and burden of disease from 2014 to 2036 in portugal

Abstract

Background/Introduction: Heart failure (HF) is a major health problem worldwide, accounting for a significant social and economic burden. As the population ages, these costs and burden are expected to increase. Purpose: To estimate, the impact of population ageing on the costs and burden of HF in Portugal between 2014 and 2036. Methods: HF costs were estimated using a prevalence-based approach. Costs and disability were assumed zero for patients in class I of the New York Heart Association (NYHA) Functional Classification. The prevalence rate was estimated using microdata from a previous epidemiological survey. Average direct costs per patient were estimated using: 1) a primary care national database with records of 25,337 patients registered with HF; 2) National DRG microdata; 3) expert panel; 4) national literature, reports and legislation. Indirect costs associated to patients' absenteeism and early exit from the labour force were considered. The burden was measured in Disability Adjusted Life Years (DALY) resulting from the sum of Years Lost due to Disability (YLD) and Years of Life Lost (YLL) due to premature death. For YLL, mortality rates reported in the European Detailed Mortality Database were considered. For YLD, disease duration and the overall incidence were estimated using the software DisMod II. Disability weights were retrieved from published literature. Population ageing was carried out by a shift-share analysis using the official demographic projections. Results: Considering only population ageing, HF prevalence (class II-IV) is expected to increase by 27%, reaching over 318,000 patients in 2036. Total costs in 2014 and 2036 are estimated, respectively, at €405M and €503M (at today's prices), with an increase in the costs per inhabitant of 33%. In 2036, total DALY are expected to be 28% higher than in 2014, from 21,162 to 27,059. The contribution of YLL will increase from 54% to 62%. Conclusions: Population ageing will substantially increase the burden of HF in Portugal. The healthcare system needs to strengthen strategies to better deal with this expected growing problem. Specifically, cardiologists should play a key role in this public health endeavour.