The direct health-care burden of valvular heart disease: evidence from US national survey data

Abstract

Purpose

This study quantified the overall effects of aortic valve disease (AVD) and mitral valve disease (MVD) by disease severity on direct health-care costs to insurers and patients.

Materials and methods

Based on 1996–2011 data from the Medical Expenditure Panel Survey (MEPS), a large, nationally representative US database, multivariate analyses were performed to assess the relationship between AVD and MVD and direct annual health-care costs to insurers and patients, at individual and US-aggregate levels. Adults aged 18 years and over with diagnosis codes for AVD or MVD based on International Classification of Diseases (ninth revision) diagnosis codes were identified. Subjects were further classified as symptomatic AVD, asymptomatic AVD, symptomatic MVD, and asymptomatic MVD. These classifications were determined with clinical assistance and based in part on data availability in the MEPS.

Results

The MEPS database included 148 patients with AVD: 53 patients with symptomatic AVD, 95 patients with asymptomatic AVD, and 1,051 with MVD, including 315 patients with symptomatic MVD and 736 patients with asymptomatic MVD. Symptomatic AVD had the largest incremental effect on annual per patient health-care expenditure: $12,789 for symptomatic AVD, $10,816 for asymptomatic AVD, $5,163 for symptomatic MVD, and $1,755 for asymptomatic MVD. When aggregated to the US population, heart-valve disease accounted for an incremental annual cost of $23.4 billion. The largest aggregate annual costs were incurred by patients with symptomatic MVD ($7.6 billion), followed by symptomatic AVD ($5.6 billion), asymptomatic MVD ($5.6 billion), and asymptomatic AVD ($4.6 billion).

Conclusion

The annualized incremental costs of heart-valve disease were substantial for all groups examined, and greatest for patients with symptomatic MVD. This reflects the relatively high prevalence associated with this group. With a growing and aging population, the prevalence of heart-valve disease is expected to rise, increasing the burden on public health.

Keywords:

• aortic valve disease
• mitral valve disease
• direct health-care costs
• Medical Expenditure Panel Survey

Supplementary materials

Table S1 ICD-9 codes for identifying aortic valve disease patients

Table S2 Methods for stratifying subjects by symptom status

Acknowledgments

The abstract of this paper was presented at ISPOR, May 19, 2015 in Philadelphia, PA as a poster presentation with interim findings. The abstract was published in Value in Health. Two additional abstracts of this paper were presented at AHA QCOR, March 1, 2016 in Phoenix, AZ as a poster presentation with interim findings. The abstract was published in Circulation: Cardiovascular Quality and Outcomes.

Disclosure

MM is an employee of Edwards Lifesciences Inc, the study sponsor. At the time of the study, PJM was an employee of CTI Clinical Trial and Consulting Services Inc. JAR is an academic affiliate of CTI, which is a consultant to Edwards Lifesciences Inc. JC reports no conflicts of interest in this work.