The Economic Burden of Heart Conditions in Brazil

Abstract Background: Heart conditions impose physical, social, financial and health-related quality of life limitations on individuals in Brazil. Objectives: This study assessed the economic burden of four main heart conditions in Brazil: hypertension, heart failure, myocardial infarction, and atrial fibrillation. In addition, the cost-effectiveness of telemedicine and structured telephone support for the management of heart failure was assessed. Methods: A standard cost of illness framework was used to assess the costs associated with the four conditions in 2015. The analysis assessed the prevalence of the four conditions and, in the case of myocardial infarction, also its incidence. It further assessed the conditions’ associated expenditures on healthcare treatment, productivity losses from reduced employment, costs of providing formal and informal care, and lost wellbeing. The analysis was informed by a targeted literature review, data scan and modelling. All inputs and methods were validated by consulting 15 clinicians and other stakeholders in Brazil. The cost-effectiveness analysis was based on a meta-analysis and economic evaluation of post-discharge programs in patients with heart failure, assessed from the perspective of the Brazilian Unified Healthcare System (Sistema Unico de Saude). Results: Myocardial infarction imposes the greatest financial cost (22.4 billion reais/6.9 billion USD), followed by heart failure (22.1 billion reais/6.8 billion USD), hypertension (8 billion reais/2.5 billion USD) and, finally, atrial fibrillation (3.9 billion reais/1.2 billion USD). Telemedicine and structured telephone support are cost-effective interventions for achieving improvements in the management of heart failure. Conclusions: Heart conditions impose substantial loss of wellbeing and financial costs in Brazil and should be a public health priority.

研究背景：心脏疾病会对巴西民众造成生理、社交、经济及健康相关生活质量层面的多重限制。
研究目的：本研究旨在评估巴西四类主要心脏疾病的经济负担，分别为高血压（hypertension）、心力衰竭（heart failure）、心肌梗死（myocardial infarction）与心房颤动（atrial fibrillation）；此外还评估了远程医疗与结构化电话支持在心力衰竭管理中的成本效益。
研究方法：本研究采用标准疾病成本框架，对2015年上述四类疾病的相关成本进行核算。分析涵盖了四类疾病的患病率，其中针对心肌梗死还额外统计了其发病率；同时核算了疾病相关的医疗保健支出、就业减少导致的生产力损失、正式与非正式护理成本，以及健康福祉损失。本次分析依托针对性文献综述、数据梳理与建模完成，所有输入参数与分析方法均通过咨询巴西境内15名临床医师及其他利益相关方完成验证。成本效益分析则基于针对心力衰竭患者出院后干预项目的荟萃分析与经济评价，分析视角采用巴西统一医疗体系（Sistema Unico de Saude）。
研究结果：结果显示，心肌梗死带来的经济负担最高，达224亿雷亚尔/69亿美元；其次为心力衰竭（221亿雷亚尔/68亿美元）、高血压（80亿雷亚尔/25亿美元），最后为心房颤动（39亿雷亚尔/12亿美元）。远程医疗与结构化电话支持可作为改善心力衰竭管理的高成本效益干预手段。
研究结论：综上，心脏疾病会给巴西带来巨额健康福祉损失与经济成本，应将其列为公共卫生优先事项。