An Unhealthy America: The Economic Burden of ... - Milken Institute

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An Unhealthy AmericaMilken InstituteHYPERTENSIONWhile hypertension (high blood pressure) has some debilitating symptoms, the prime risks to patients and health-carecosts are tied to comorbidities with heart disease and stroke. High blood pressure is preventable but also very common;approximately one in three adults develops the disease. Even more troubling, about 30 percent of all cases areundiagnosed. 55 Furthermore, 11 percent of those diagnosed are not on therapy, and 25 percent are on inadequatetherapy, leading to increased risk of heart disease or stroke. Here, too, obesity and high BMI are causal factors inprevalence.More than 40 percent of Americans have high blood pressure. The disease killed approximately 49,707 Americans in2002 and was listed as the primary or contributing cause in about 261,000 deaths in 2002. 56Hypertension is controllable through lifestyle and dietary changes. These include weight control, exercise, propernutrition, and limiting alcohol consumption. Current drug treatments include angiotension-converting enzymeinhibitors, angiotensin receptor blockers (ARBs), diuretics, beta-blocker, alpha-blockers, alpha-beta-blockers, calciumchannel blockers, nervous system inhibitors, and vasodilators. Combination drug therapies are often used. 57Age Demographics OnlyThe ratio of the prevalence rate for hypertension for the 65–74 age group relative to the 25–44 age group is 5.5.This means that an individual between 65 and 74 is 5.5 times more likely to develop hypertension than someoneunder 50. The aging population will affect the overall prevalence rate. Based solely upon the aging population,hypertension PRC jumps 38.2 percent between 2003 and 2023.Baseline ScenarioModerate increases in exercise rates will largely counteract rising obesity. Nonetheless, the net impact ofbehavioral risks push hypertension PRC to an additional 2,118,861 (4.2 percent) relative to aging demographicsalone. More widespread use of existing medications and FDA approval of new ones to delay or eliminate theonset of the disease cut PRC by 1,788,337 in 2023. PRC increases by 39.1 percent between 2003 and 2023, justhigher than where aging alone would push it. Total hypertension PRC reaches 51,138,353.Of total treatment costs, hypertension has the highest prescription drug share, at 53.5 percent, and the lowestinpatient hospital care, at 14.0 percent. Based on projections of medical-care cost growth, expenditures perPRC rise 91.5 percent between 2003 and 2023, an increase of 3.3 percent annually. Expenditures per PRC growfrom $885 in 2003 to $1,694 in 2023. Total treatment expenditures rise from $32.5 billion in 2003 to $88.2 billionin 2023, a 171.0 percent escalation. The nation will pay $1.2 trillion cumulatively over the next twenty years intreatments.55. Centers for Disease Control and Prevention. See: http://www.cdc.gov/bloodpressure/facts.htm and American HeartAssociation. See: http://www.americanheart.org/presenter.jhtml?identifier=212.56. http://www.americanheart.org/downloadable/heart/1110821765203FS14HBP5.REVdoc. See also: http://www.cdc.gov/dhdsp/library/fs_bloodpressure.htm.57. Centers for Disease Control and Prevention. See: http://www.cdc.gov/bloodpressure/about.htm and WebMD: http://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-treatment-overview.[ 107 ]
An Unhealthy AmericaMilken InstituteOptimistic ScenarioChanges in obesity and exercise levels prevent the rapid progression of prevalence. Hypertension PRC is cut by8,822,657 (a 16.7 percent reduction) in this scenario. Prescription drug innovations reduce PRC by 2,526,382(5.7 percent) in 2023. We project 9,560,602 fewer PRC (18.7 percent) than in the baseline. The prevalence ratepeaks in 2010 and declines moderately thereafter.Expenditures per PRC are 9.3 percent lower ($157 less) than in the baseline by 2023. Total treatment expendituresincrease 99.4 percent between 2003 and 2023, when they hit $64.9 billion.Direct Avoidable CostsThe behavioral changes evaluated in the optimistic scenario would reduce future hypertension treatmentexpenditures appreciably. The difference between the baseline and optimistic expenditure projectionsprovides an approximation of the avoidable costs. By 2023, expenditures are 26.4 percent ($23.30 billion) belowthe baseline. The cumulative difference between the optimistic and baseline over the projection interval is$179.6 billion.HypertensionHypertensionPRC (Thousands)Expenditures per PRC ($) Total (US$ Billions)Expenditures PRC* Expenditures/PRCDemographicsYear Disease Only Baseline Optimistic (Billions) Baseline (Millions) Optimistic (Thousands)Baseline Optimistic2003 Cancer 36,761 36,761 36,761 48.1 885 10.6 885 4.5 32.5 32.52023 50,808 51,138 41,578 1,694 1,538 88.2 64.9Breast Cancer 5.5 1.1 4.8Percent Change2003-2023 Colon Cancer 38.2 39.1 13.1 3.9 91.5 0.3 73.8 11.5 171.0 99.4Source: Milken Institute Lung Cancer 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes Hypertension Hypertension27.1- Avoidable 13.7 Costs2.0Hypertension Avoidable 32.5 Costs 36.8 0.9US$ BillionsHeart Disease25Expenditures 64.7 PRC* 19.2 Expenditures/PRC 3.4Stroke Expenditures 13.6 PRC* 2.4 Expenditures/PRCDisease(Billions) (Millions) (Thousands) 5.6Disease Mental Disorders (Billions) 45.8 (Millions) 30.3 (Thousands)Cancer 48.1 10.6 4.5 1.5Cancer Total 20277.0 48.1 162.2 10.6 4.5Breast Cancer 5.5 1.1 4.81.7PRC: BreastColon Population CancerCancer Reporting Condition 5.53.91.10.3 11.54.8Colon Cancer 153.9 0.3 11.5Lung Cancer 6.3 0.4 17.1Lung Cancer 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1ProstateOther CancersCancer 4.3 1.0 4.11028.0 7.7 3.6Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9PulmonaryDiabetesConditions 45.227.149.213.70.92.0Diabetes527.1 13.7 2.0Hypertension 32.5 36.8 0.9Hypertension 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4HeartStrokeDisease 064.713.619.22.43.45.6Stroke 2005 2008 2011 13.620142017 2.4 2020 2023 5.6Mental Disorders Source: Milken Institute 45.8 30.3 1.5MentalTotalDisorders277.045.8162.230.3 1.51.7Total 277.0 162.2 1.7PRC: Population Reporting ConditionPRC: Population Reporting Condition[ 108 ]
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