ABC | Volume 111, Nº1, July 2018

Original Article The Economic Burden of Heart Conditions in Brazil Bryce Stevens, 1 Lynne Pezzullo, 1 Lara Verdian, 1 Josh Tomlinson, 1 Alice George, 1 Fernando Bacal 2 Deloitte Access Economics Pty Ltd, 1 Austrália Instituto do Coração (InCor) - HC-Faculdade de Medicina da USP, 2 São Paulo, SP – Brazil Mailing Address: Alice George • 8 Brindabella Circuit, 2609, Canberra Airport, Canberra – Australia E-mail: algeorge@deloitte.com.au, brstevens@deloitte.com.au Mansucript received February 02, 2017, revised manuscript July 14, 2017, accepted July 31, 2017 DOI: 10.5935/abc.20180104 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. (Arq Bras Cardiol. 2018; 111(1):29-36) Keywords: Cardiovascular Diseases/economics; Hypertension; Heart Failure; Myocardial Infarction; Atrial Fibrillation. Introduction Heart conditions impose physical, social, financial and health- related quality of life limitations on individuals. These conditions result in an economic burden and impact on society due to expenditures on healthcare treatment, productivity losses from employment impacts, costs of providing formal and informal care, and lost wellbeing. Circulatory diseases presently represent the biggest health burden worldwide, accounting for over 17 million deaths every year; this represents half of all noncommunicable disease deaths. 1 At the 2016World Congress of Cardiology & Cardiovascular Health, the Mexico Declaration for Circulatory Health was signed by leading global organisations committed to improving circulatory health and reducing deaths and disability from heart diseases and stroke around the world. This is aligned with a clear target, set by the World Health Organization (WHO) and signed by country signatories, of reducing deaths from noncommunicable disease by 25 per cent by 2025. 1 Our analysis identifies the current burden heart conditions have on Brazil and consequently the potential economic benefits that could result from addressing it. This study aims to assess the economic (health system and productivity) impact of four heart conditions in Brazil, providing estimates of the annual cost for the year 2015: hypertension (HTN), myocardial infarction (MI), atrial fibrillation (AF) and heart failure (HF). This study also analyzes the cost-effectiveness of two interventions for HF: telemedicine (TM) and structured telephone support (STS). Method This research is part of a larger study of the Latin American region, with country-specific results also identified for Mexico, Chile, Peru, Venezuela, Colombia, Ecuador, Panama and El Salvador. These results for Brazil were presented at ISPOR Vienna (November 2016) and the World Cardiovascular Congress (June 2016). 29