Treating chest pain associated with coronary artery disease (CAD) could cost a woman more than $1 million during her lifetime; and even the chest pain associated with mild artery blockage (nonobstructive CAD) could reach $750,000 for an average woman, according to a study published in Circulation.
Chest pain symptoms may be the most important driver of women's cardiovascular healthcare costs, said lead study author Leslee J. Shaw, Ph.D. "Lifetime healthcare costs can reach $1 million for each woman with heart disease in this country," she said. "The societal burden for coronary artery disease for women with chest pain is expensive and could be responsible for a sizeable portion of U.S. healthcare costs."
Researchers investigated the economic burden of cardiac symptoms on women. Shaw and investigators from the Women's Ischemia Syndrome Evaluation (WISE) study reviewed data on 883 women who had been referred for coronary angiography and compared data on their health, finances and quality of life for at least five years. Coronary angiography is a specialized X-ray examination of the coronary arteries and is one of the most frequently preformed procedures in women.
Researchers found that 62 percent of women studied had nonobstructive coronary artery disease – defined as blockage less than 50 percent of the artery. Seventeen percent had one coronary artery vessel blocked or narrowed, 11 percent had two vessels narrowed and 10 percent had three vessels affected.
Even if a physician does not identify a CAD obstruction, women may still have persistent chest pain symptoms, which can result in expensive medical bills over time, said Shaw, who was at Cedars-Sinai Research Institute at the Cedars-Sinai Medical Center in Los Angeles at the time the study was conducted.
"Almost two-thirds of these women had heart disease, but it was nonobstructive – there was no lesion or blockage, no significant narrowing of the vessels, nothing to be considered high-risk. So we assumed that these women would not have as many healthcare needs as those with blockage of one, two or three blood vessels," Shaw said. "But we found that the key factor was ongoing angina – the chest pain or discomfort that occurs when your heart doesn't get as much blood and oxygen as it needs. It was a very prominent driver of the need for clinical care, outpatient therapy, hospitalization and drug therapies."
Within the first year, the number of repeat angiograms or hospitalizations for chest pain was 1.8-fold higher in women with nonobstructive CAD vs. one-vessel CAD. Twenty percent of women with nonobstructive CAD, and up to 55 percent of women with three-vessel CAD, were hospitalized for chest pain within five years.
Drug treatment costs were highest for those with nonobstructive or one-vessel CAD. Drugs to treat ischemia – the lack of blood flow and oxygen to the heart muscle – represented 14.8 percent of total costs in women with nonobstructive disease, and ranged from 13.6 percent to 12.1 percent of total costs for those with one- to three-vessel CAD.
For women with nonobstructive CAD, the average lifetime cost estimate was $767,288. For women with one- to three-vessel CAD, the estimates exceeded $1 million. These figures included medical care and estimates of indirect costs such as hours lost from work, reduced productivity hours, transportation costs, and out-of-pocket costs for drugs, medical devices and alternative therapies.
Within the study's five-year span, women with nonobstructive CAD spent an average of $32,239 on their health care, a figure that increased to $53,398 for women with three-vessel CAD. Costs of drugs, including those to treat hypertension and diabetes, made up 32.6 percent of total costs for women with nonobstructive CAD over five years.
"Nearly half of the WISE women had an annual household income of less than $35,000 a year, so indirect costs took up about 10 percent of their financial resources, and that was surprising," Shaw said. "Further, because many have no prescription drug coverage and these are not low-cost drugs, prescriptions can eat up a lot of their resources. So they're either paying for the drugs out-of-pocket or they simply don't take them. "It's easy for doctors to write a prescription, but they must be aware of other, nonmedical repercussions that their patients may not be able to handle financially, down the road."
C. Noel Bairey Merz, M.D.; Carl J. Pepine, M.D.; Steven E. Reis, M.D.; Vera Bittner, M.D.; Kevin Kip, Ph.D.; Sheryl F. Kelsey, Ph.D.; Marian Olson, M.S.; B. Delia Johnson, Ph.D.; Sunil Mankad, M.D.; Barry L. Sharaf, M.D.; William J. Rogers, M.D.; Gerald M. Pohost, M.D.; and George Sopko, M.D.
This work was supported by contracts from the National Heart, Lung, and Blood Institutes.Editor's note:
Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.
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