Author + information
- Received October 11, 2017
- Revision received December 20, 2017
- Accepted December 26, 2017
- Published online March 5, 2018.
- Leslee J. Shaw, PhDa,∗ (, )
- Abhinav Goyal, MD, MHSa,
- Christina Mehta, PhDb,
- Joe Xie, MDa,
- Lawrence Phillips, MDc,
- Anita Kelkar, MDa,
- Joseph Knapper, MDa,
- Daniel S. Berman, MDd,
- Khurram Nasir, MD, MPHe,
- Emir Veledar, PhDe,
- Michael J. Blaha, MD, MPHf,
- Roger Blumenthal, MDf,
- James K. Min, MDg,
- Reza Fazel, MDa,
- Peter W.F. Wilson, MDa and
- Matthew J. Budoff, MDh
- aEmory University School of Medicine, Atlanta, Georgia
- bEmory University School of Public Health, Atlanta, Georgia
- cNew York University School of Medicine, New York, New York
- dCedars-Sinai Medical Center, Los Angeles, California
- eBaptist Health South Florida, South Miami, Florida
- fJohns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
- gWeill Cornell Medical College, New York, New York
- hUniversity of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Leslee J. Shaw, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Room 529, Atlanta, Georgia 30324.
Background Cardiovascular disease (CVD) imparts a heavy economic burden on the U.S. health care system. Evidence regarding the long-term costs after comprehensive CVD screening is limited.
Objectives This study calculated 10-year health care costs for 6,814 asymptomatic participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a registry sponsored by the National Heart, Lung, and Blood Institute, National Institutes of Health.
Methods Cumulative 10-year costs for CVD medications, office visits, diagnostic procedures, coronary revascularization, and hospitalizations were calculated from detailed follow-up data. Costs were derived by using Medicare nationwide and zip code–specific costs, inflation corrected, discounted at 3% per year, and presented in 2014 U.S. dollars.
Results Risk factor prevalence increased dramatically and, by 10 years, diabetes, hypertension, and dyslipidemia was reported in 19%, 57%, and 53%, respectively. Self-reported symptoms (i.e., chest pain or shortness of breath) were common (approximately 40% of enrollees). At 10 years, approximately one-third of enrollees reported having an echocardiogram or exercise test, whereas 7% underwent invasive coronary angiography. These utilization patterns resulted in 10-year health care costs of $23,142. The largest proportion of costs was associated with CVD medication use (78%). Approximately $2 of every $10 were spent for outpatient visits and diagnostic testing among the elderly, obese, those with a high-sensitivity C-reactive protein level >3 mg/l, or coronary artery calcium score (CACS) ≥400. Costs varied widely from <$7,700 for low-risk (Framingham risk score <6%, 0 CACS, and normal glucose measurements at baseline) to >$35,800 for high-risk (persons with diabetes, Framingham risk score ≥20%, or CACS ≥400) subgroups. Among high-risk enrollees, CVD costs accounted for $74 million of the $155 million consumed by MESA participants.
Conclusions Longitudinal patterns of health care resource use after screening revealed new evidence on the economic burden of treatment and testing patterns not previously reported. Maintenance of a healthy population has the potential to markedly reduce the economic burden of CVD among asymptomatic individuals.
Support was provided by the National Heart, Lung, and Blood Institute, National Institutes of Health (grant RC1 HL100915-01). Dr. Min has served as a member of the scientific advisory board of Arineta; has ownership in MDDX; and has a research agreement with GE Healthcare. Dr. Budoff has received grants from the National Institutes of Health and GE. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 11, 2017.
- Revision received December 20, 2017.
- Accepted December 26, 2017.
- 2018 American College of Cardiology Foundation
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