Economic Costs of Cardiac Illness and Mental Health Diagnoses

In recent years, employers, health plans and other health care organizations have been monitoring medical and pharmaceutical costs in an effort to curb the year-over-year, double-digit increases in health care costs. Heart disease, the most costly of all disease states, accounts for 18 percent of all illness-related costs.¹ 

Any evaluation of the financial impact of heart disease must include an assessment of direct and indirect costs. Direct expenses include the cost of physicians and other professionals, hospitals, nursing homes, medications, home health care and other medical durables. Added to direct costs, and accounting for a significant percentage of the total financial impact of heart disease, are the costs associated with loss of productivity due to illness and death. Absenteeism, short-term disability and “presenteeism” (defined as the decrease in worker productivity because of illness) are all factors that must be included in the calculation of the overall cost of heart disease.

Costs of heart disease

In 2005 the Centers for Disease Control and Prevention projected the annual cost of heart disease to exceed $394 billion. Of this number, $242 billion (61 percent) were attributable to direct costs, and $152 billion (39 percent) were attributed to lost productivity from death and disability. Additionally, $60 billion in health care spending were attributed to high blood pressure, a condition that is often associated with heart disease.²

In a 2004 study published in the Journal of Occupational and Environmental Medicine, researchers found that presenteeism accounted for 60 percent of employer costs. When combining presenteeism, absenteeism and health and disability benefits, the second most expensive condition identified for employers was heart disease.³

A 1999 study showed that incidental absences, in which employees call in “sick” for short periods, exerted greater financial losses to employers than events paid for by short-term disability programs. Absence-related losses accounted for 20 percent of total health costs, while short-term disability costs accounted for only 9 percent.⁴ These same ratios apply to cardiovascular disease and behavioral health diagnoses, showing clearly that the day-to-day absences incurred because of these diagnoses have a considerable impact on a company’s bottom line. In addition, cardiovascular disease remains the leading cause of disability among working adults.⁵

Heart disease and mental health diagnoses

As with many illnesses, heart disease often is associated with other disorders. Of particular note is the association between heart disease and mental health diagnoses.

Depression develops in one in four people who have had heart attacks. When depression and heart disease are present together, the risk of death is three-and-a-half times greater than it is for people with heart disease who are not depressed.⁶ Also, major depression is diagnosed in 45 percent of individuals hospitalized after a heart attack. This diagnosis of depression is not consequent to feelings of intense sadness or loss that are typical when someone is newly diagnosed with a medical condition; rather the diagnosis of depression signifies the presence of a second, distinct disease: depression. Studies have found that individuals with a diagnosis of coronary artery disease (CAD) who were treated with selective antidepressants for six months were 91 percent more likely to experience a significant reduction in the cost of hospital inpatient services and 72 percent more likely to experience a significant reduction in the cost of office-based services in the treatment of their diseases.⁷

The co-occurrence of heart disease and mental health conditions has a significant impact on an employer’s bottom line because mental health conditions are not always properly diagnosed and they often are under treated. Health care professionals focusing on the treatment of cardiac illness may not be aware of the signs and symptoms of depression or may attribute the signs to other physical conditions; patients may not recognize or report symptoms. For some, the signs and symptoms of untreated depression and other mental health concerns have been present for such a prolonged period that they have become a “normal” part of everyday life, and individuals do not perceive them to be signs of illness.

A comparison of health care costs for individuals diagnosed with CAD who also have a diagnosis of depression and/or anxiety versus those who do not have the mental illness diagnosis illustrates the significant difference in medical health costs, exclusive of the cost of behavioral health treatment:

• The cost to the employer for the physical health care of CAD patients without behavioral health diagnoses was $883 per member per month.
• These costs rose 54% to $1,358 per member per month for CAD patients with depression or anxiety.⁸

According to a 2003 survey reported in the Journal of the American Medical Association that asked participants about their wages and lost hours, depression costs employers $44 billion a year in lost productivity (primarily related to presenteeism). That figure is $31 billion more than the amount lost due to illnesses other than depression.⁹

While the industry has evaluated the impact of depression and anxiety on overall medical costs associated with medical treatment, other behavioral health diagnoses can be assumed to have a similar effect on overall health care costs.

Conclusion

The direct and indirect costs for cardiac illness and mental health diagnoses clearly are individually significant. When these diagnoses co-occur, however, costs are compounded. It is vital to an organization’s efforts to contain overall health costs as well as reduce absenteeism and presenteeism that they consider the relationship between these conditions when creating an integrated cardiovascular/behavioral health program. Please see the “About” section for more on the connection between heart disease and mental health, including a discussion of changing behavior to reduce risk. 

Note: Obesity and tobacco use often are associated with heart disease. For more information on the costs of these conditions as well as program strategies, please see the “Resources” section.

1 Genesee County, New York, Department of Public Health
2 Centers for Disease Control and Prevention
3 WebMD
4 Journal of Occupational Medicine, January 2003;45:5-14
5 National Mental Health Association
6 “More Americans Seeking Help for Depression” by Mary Duenwald. New York Times: A1, A22 (Col. 2), June 18, 2003.
7 Group Health Inc. (GHI)
8 ValueOptions/IHCIS Comorbidity Study, 2003
9 “More Americans Seeking Help for Depression” by Mary Duenwald. New York Times: A1, A22 (Col. 2), June 18, 2003.