The impact of ageing on the future costs and burden of heart failure in Portugal

Objectives: To estimate, the impact of population ageing on the costs and burden of Heart Failure (HF) in Portugal over a twenty-year horizon, between 2014 and 2034. MethOds: HF costs were estimated using a prevalence-based approach. Costs and disability were assumed zero for patients in class I of the New York Heart Association (NYHA) Functional Classification. The prevalence rate was estimated using microdata from a previous epidemiological survey. Average direct costs per patient were estimated using: 1) a primary care national database with records of 25,337 patients registered with HF; 2) National DRG microdata; 3) expert panel; 4) national literature, reports and legislation. Indirect costs associated to patients’ absenteeism and early exit from the labour force were considered. The burden was measured in Disability Adjusted Life Years (DALY) resulting from the sum of Years Lost due to Disability (YLD) and Years of Life Lost (YLL) due to premature death. For YLL, mortality rates reported in the European Detailed Mortality Database were considered. For YLD, disease duration and the overall incidence were estimated using the software DisMod II. Disability weights were retrieved from published literature. Population ageing was carried out by a shift-share analysis using the official demographic projections. Results: Considering only population ageing on a 20-year horizon, HF prevalence (class II-IV) is expected to increase by 25%, reaching over 312,000 patients in 2034. Total costs in 2014 and 2034 are estimated, respectively, at €289M and €364M (at today’s prices), with an increase in the costs per inhabitant of 34%. In 2034, total DALY are expected to be 25% higher than in 2014, from 21,162 to 26,521. The contribution of YLL will increase from 54% to 61%. cOnclusiOns: Population ageing will substantially increase the burden of HF in Portugal. Health policy makers should consider new strategies to deal with this problem.