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. 2018 May;6(5):401-409.
doi: 10.1016/j.jchf.2017.12.006. Epub 2018 Mar 7.

Innovation in Heart Failure Treatment: Life Expectancy, Disability, and Health Disparities

Karen E Van Nuys  1 , Zhiwen Xie  2 , Bryan Tysinger  2 , Mark A Hlatky  3 , Dana P Goldman  2
Affiliations

Innovation in Heart Failure Treatment: Life Expectancy, Disability, and Health Disparities

Karen E Van Nuys et al. JACC Heart Fail. 2018 May.

Abstract

Objectives: The goal of this study was to illustrate the potential benefit of effective congestive heart failure (CHF) treatment in terms of improved health, greater social value, and reduced health disparities between black and white subpopulations.

Background: CHF affects 5.7 million Americans, costing $32 billion annually in treatment expenditures and lost productivity. CHF also contributes to health disparities between black and white Americans: black subjects develop CHF at a younger age and are more likely to be hospitalized and die of this disease. Improved CHF treatment could generate significant health benefits and reduce health disparities.

Methods: We adapted an established economic-demographic microsimulation to estimate scenarios in which a hypothetical innovation eliminates the incidence of CHF and, separately, 6 other diseases in patients 51 to 52 years of age in 2016. This cohort was followed up until death. We estimated total life years, quality-adjusted life years, and disability-free life years with and without the innovation, for the population overall and for race- and sex-defined subpopulations.

Results: CHF prevalence among 65- to 70-year-olds increased from 4.3% in 2012 to 8.5% in 2030. Diagnosis with CHF coincided with significant increases in disability and medical expenditures, particularly among black subjects. Preventing CHF among those 51 to 52 years of age in 2016 would generate nearly 2.9 million additional life years, 1.1 million disability-free life years, and 2.1 million quality-adjusted life years worth $210 to $420 billion. These gains are greater among black subjects than among white subjects.

Conclusions: CHF prevalence will increase substantially over the next 2 decades and will affect black Americans more than white Americans. Improved CHF treatment could generate significant social value and reduce existing health disparities.

Keywords: disability; health disparities; heart failure; medical spending.

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Figures

Figure 1
Figure 1
Prevalence of Congestive Heart Failure Among U.S. 65-70 Year Olds Sources: Health & Retirement Survey, and the Future Elderly Model Simulation
Figure 2
Figure 2
Age-Adjusted Percent of CHF Population Reporting Limitations in 3 or More Activities of Daily Living, Before and After CHF Diagnosis, by Race and Gender Source: Health & Retirement Survey 2000 to 2012 Data
Figure 3
Figure 3
Annual Per-Capita Medical Expenditures, by Race and Gender Source: Health & Retirement Survey 2000 to 2012 Data
Figure 4
Figure 4
Average Gain in Selected Outcomes from Eliminating Seven Conditions (Among Those Affected) Panel A –Life Expectancy in Years Panel B – Disability-Free Life Years Panel C – Quality-Adjusted Life Years Source: The Future Elderly Model Analysis
Figure 4
Figure 4
Average Gain in Selected Outcomes from Eliminating Seven Conditions (Among Those Affected) Panel A –Life Expectancy in Years Panel B – Disability-Free Life Years Panel C – Quality-Adjusted Life Years Source: The Future Elderly Model Analysis
Figure 4
Figure 4
Average Gain in Selected Outcomes from Eliminating Seven Conditions (Among Those Affected) Panel A –Life Expectancy in Years Panel B – Disability-Free Life Years Panel C – Quality-Adjusted Life Years Source: The Future Elderly Model Analysis
Figure 5
Figure 5
Average Gain in Selected Outcomes from Eliminating Congestive Heart Failure (Among Those Affected), by Race and Gender Panel A –Life Expectancy in Years Panel B –Disability-Free Life Years Panel C – Quality-Adjusted Life Years Source: The Future Elderly Model Analysis
Figure 5
Figure 5
Average Gain in Selected Outcomes from Eliminating Congestive Heart Failure (Among Those Affected), by Race and Gender Panel A –Life Expectancy in Years Panel B –Disability-Free Life Years Panel C – Quality-Adjusted Life Years Source: The Future Elderly Model Analysis
Figure 5
Figure 5
Average Gain in Selected Outcomes from Eliminating Congestive Heart Failure (Among Those Affected), by Race and Gender Panel A –Life Expectancy in Years Panel B –Disability-Free Life Years Panel C – Quality-Adjusted Life Years Source: The Future Elderly Model Analysis
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