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 2009 the Centers for Disease Control and Prevention projected the annual cost of heart disease to exceed $475 billion. Additionally, $73 billion in health care spending were attributed to high blood pressure, a condition that is often associated with heart disease.2
In a 2008 study conducted by Kalorama Information, researchers found that presenteeism cost employers $160 billion in lost productivity.3 When combining presenteeism, absenteeism and health and disability benefits, the second most expensive condition identified for employers is heart disease. The highest cost to employers is high blood pressure. 4
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 1 in 5 people who have had heart attacks. When depression and heart disease are present together, the risk of death is 2 to 3 times greater than it is for people with heart disease who are not depressed. Also, major depression is diagnosed in 20 percent of individuals hospitalized after a heart attack.5 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 6 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.6
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.7
Depression costs employers $51.5 billion a year in lost productivity (primarily related to presenteeism). Depressed employees cost employers more than $4,000 per year in medical services compared to less than $1,000 per year for employees without depression. 8
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.
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 Kalorama Information
4 Institute for Health and Productivity Studies, Cornell University
5 Johns Hopkins University
6 Group Health Inc. (GHI)
7 ValueOptions/IHCIS Comorbidity Study, 2003
8 Managed Care Magazine (2006)