What will the cardiovascular disease slowdown cost? Modelling the impact of CVD trends on dementia, disability, and economic costs in England and Wales from 2020-2029

Abstract

Background: There is uncertainty around the health impact and economic costs of the recent slowing of the historical decline in cardiovascular disease (CVD) incidence and the future impact on dementia and disability.

Methods: Previously validated IMPACT Better Ageing Markov model for England and Wales, integrating English Longitudinal Study of Ageing (ELSA) data for 17,906 ELSA participants followed from 1998 to 2012, linked to NHS Hospital Episode Statistics. Counterfactual design comparing two scenarios: Scenario 1. CVD Plateau-age-specific CVD incidence remains at 2011 levels, thus continuing recent trends. Scenario 2. CVD Fall-age-specific CVD incidence goes on declining, following longer-term trends. The main outcome measures were age-related healthcare costs, social care costs, opportunity costs of informal care, and quality adjusted life years (valued at £60,000 per QALY).

Findings: The total 10 year cumulative incremental net monetary cost associated with a persistent plateauing of CVD would be approximately £54 billion (95% uncertainty interval £14.3-£96.2 billion), made up of some £13 billion (£8.8-£16.7 billion) healthcare costs, £1.5 billion (-£0.9-£4.0 billion) social care costs, £8 billion (£3.4-£12.8 billion) informal care and £32 billion (£0.3-£67.6 billion) value of lost QALYs.

Interpretation: After previous, dramatic falls, CVD incidence has recently plateaued. That slowdown could substantially increase health and social care costs over the next ten years. Healthcare costs are likely to increase more than social care costs in absolute terms, but social care costs will increase more in relative terms. Given the links between COVID-19 and cardiovascular health, effective cardiovascular prevention policies need to be revitalised urgently.

Fig 1. Modelled CVD incidence per 100,000 population aged 35–100, prevalence (% of people aged 35–100), and mortality per 100,000 population aged 35–100, from 2005 to 2030, comparing Scenario 2 (Continuing decline in CVD incidence) with Scenario 1 (plateaued CVD incidence).

Fig 2. Modelled healthcare costs, social care costs, value of informal care, and QALYs, from 2020–2029, comparing Scenario 2 (Continuing decline in CVD incidence) with Scenario 1 (plateaued CVD incidence).

Healthcare costs are total NHS costs based on ELSA data linked with NHS England HES data. Social care costs are based on ELSA and include cleaner, care/nursing home staff, other formal help, Local Authority-provided home care worker/ home help, and non-Local Authority home care worker/ home help, as well as residential care. Informal care costs are based ELSA data multiplied by ONS estimates of gross value added per hour of care. QALYs are quality adjusted life years experienced per year, across the whole population, aged 35–100.