A review of the economics of adult congenital heart disease

Abstract

Adults living with congenital heart disease (CHD) now outnumber children with the disease. Thanks to medical advances over the past 75 years, many of these fatal childhood heart problems have changed to chronic medical conditions. As the population of adults with CHD increases, they will require increasingly complex medical, surgical and catheter-based therapies. In addition, social burdens including education, employment and insurability, which increase the societal costs of adult CHD, are now being recognized for adults living with CHD. This review summarizes the available literature on the economics of adult CHD.

KeyWords:

• Adult congenital heart disease
• healthcare resource utilization
• tetralogy of Fallot
• atrial septal defects
• Hypoplastic left heart syndrome
• chronic disease
• economics

Key issues

• The number of adults with CHD continues to increase.

• The proportion of those with severe CHD will continue to increase as treatments improve.

• Complex CHD requires more outpatient and inpatient cardiac care, leading to increased costs.

• Not only do these patients require more cardiac care, but the costs for treating their noncardiac conditions are higher than patients without CHD.

• Surgical and minimally invasive catheterization-based treatments continue to develop, often at higher costs, and sometimes with no clear clinical benefit to justify the newer modalities.

• Adults with CHD tend to achieve lower levels of education and have higher unemployment rates.

• These patients also experience difficulty obtaining insurance and commercial loans because of incorrect perceptions of their chronic health status.

• Regionalization of adult CHD care may help reduce complications and hospital costs, but these benefits have not been clearly demonstrated yet.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.