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

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An Unhealthy AmericaMilken InstituteSTROKEStroke is among the most debilitating chronic conditions; common symptoms include weakness or paralysis, anddiminished cognitive and communication skills. In 2003 there were approximately 700,000 new and recurrent strokeattacks. Approximately 157,800 people died from strokes that year. Prevalence was 2.6 percent of the adult population. 59Recurrence is frequent—about 25 percent of people who recover from a first stroke will have another stroke within fiveyears. 60Comorbidities, such as high blood pressure (hypertension), heart disease, or diabetes, increase the risk for stroke. Highblood pressure is the most common cause of stroke: it increases the risk by four to six times. 61 Strokes may not bealtogether preventable; however, a number of behavioral changes can reduce the risk of having a first stroke or arecurrence.Age Demographics OnlyThe aging population will have a major influence on stroke prevalence. The ratio of the prevalence rate forstroke for the 65-74 age group relative to the 25-44 age group is 14.2. Holding age-specific prevalence rates attheir 2003 level over the forecast period causes PRC to surge 47.3 percent based upon the aging of thepopulation between 2003 and 2023.Baseline ScenarioAccording to our econometrics, smoking has the strongest causal impact on stroke among behavioral riskfactors, a relationship almost as strong as its link with lung cancer. Obesity seems to be more closely tied tostroke than previously believed, but the relationship is somewhat weak. Diminished smoking rates andmoderate improvements in exercise partially offset rising obesity in the baseline scenario. As a result, PRCtotals are cut 7.2 percent relative to aging demographics alone in 2023. More widespread use of existingmedications and FDA approval of new ones to delay or eliminate the onset of the disease cut PRC by 180,598.Between 2003 and 2023, total stroke PRC increases by 28.9 percent, to 3,127,035. These estimates do not includethe institutionalized population in nursing homes, prison, or under other supervised care.Stroke has the highest inpatient hospital care share (76.7 percent) of treatment costs examined in this study.Prescription medications account for 5.4 percent of treatment costs. Based upon the projections on medicalcarecost growth, expenditures per PRC rise 105.5 percent between 2003 and 2023, an increase of 3.7 percentper year. In dollar amounts, expenditures per PRC rise from $5,596 to $11,500. Total treatment expendituresincrease from $13.6 billion in 2003 to $36.6 billion in 2023, a gain of 169.4 percent. Spending will hit $469.77billion cumulatively over the next twenty years.59. Thom Thomas et al. “Heart Disease and Stroke Statistics. 2006 Update: A Report From the American Heart AssociationStatistics Committee and Stroke Statistics Subcommittee.” Circulation, Vol. 113, No. 6, February 14, 2006. p.e85–e151.Published online before print, January 11, 2006. See: http://circ.ahajournals.org/cgi/reprint/113/6/e85.60. National Institute of Neurological Disorders and Stroke See: http://www.ninds.nih.gov/disorders/ stroke/stroke.htm.61. National Stroke Association. See: http://www.stroke.org/site/DocServer/ReducingRiskfactsheet1.doc ?docID=403and http://www.stroke.org/site/PageServer?pagename=CONT), and American Stroke Association. http://www.strokeassociation.org/presenter.jhtml?identifier=4716).[ 111 ]
An Unhealthy AmericaMilken InstituteOptimistic ScenarioLower smoking and changes in obesity and exercise levels could prevent many strokes. In this scenario, PRC iscut by 521,463 (15.8 percent) due to these behavioral changes. Prescription drug innovations reduce PRC by248,375 (8.9 percent) in 2023. Total stroke PRC is 589,240 less (18.8 percent lower) in 2023 than in the baseline.The prevalence rate slowly declines over the projection period.Expenditures per PRC are 9.2 percent lower ($1,060 lower) lower than in the baseline. Total treatmentexpenditures increase 97.9 percent between 2003 and 2023, when they reach $26.9 billion.Direct Avoidable CostsBehavioral changes reduce projected stroke treatment expenditures appreciably. The difference between thebaseline and optimistic stroke expenditure projections provides an estimate of the avoidable costs. By 2023,expenditures are 26.6 percent ($9.7 billion) below the baseline. The cumulative difference between theoptimistic and baseline over the projection interval is $72.7 billion.StrokeStrokePRC (Thousands)Expenditures per PRC ($) Total (US$ Billions)Expenditures PRC* Expenditures/PRCDemographicsYear Disease Only Baseline Optimistic (Billions) Baseline (Millions) Optimistic (Thousands)Baseline Optimistic2003 Cancer2,425 2,425 2,425 48.1 5,596 10.65,596 13.6 4.513.62023 Breast 3,565 Cancer 3,127 2,538 5.511,500 1.1 10,440 36.6 4.826.9Percent ChangeColon Cancer 3.9 0.3 11.52003-2023 47.0 28.9 4.6 105.5 86.6 169.4 97.9Source: 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 Stroke - 27.1 Avoidable 13.7 2.0Stroke CostsHypertension Avoidable 32.5 Costs 36.8 0.9Heart Disease US$ Billions64.7 19.2 3.4Stroke 10Expenditures PRC* Expenditures/PRCExpenditures 13.6 PRC* 2.4 Expenditures/PRC 5.6Disease(Billions) (Millions) (Thousands)Disease Mental Disorders (Billions) 45.8 (Millions) 30.3 (Thousands) 1.5Cancer 48.1 10.6 4.5Cancer Total 8277.0 48.1 162.2 10.6 4.5 1.7Breast Cancer 5.5 1.1 4.8PRC: Breast Population Cancer Reporting ConditionColon Cancer5.53.91.10.3 11.54.8Colon Cancer 63.9 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 4.1428.0 7.7 3.6Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9PulmonaryDiabetesConditions 45.227.149.213.70.92.0Diabetes 227.1 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 13.6 2014 2017 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[ 112 ]
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