Estimates of the direct and indirect cost savings associated with heart disease that could be avoided through dietary change in the United States

Figures & data

Figure 1. Modeling the aggregate medical care cost savings from switching to a high-MUFA diet.

Table 1. Descriptive statistics: Medical Expenditure Panel Survey, 2000–2010.

	Sample for medical expenditures analysis: adults age ≥18 (n = 247,700)	Sample for work loss days analysis: adults age ≥18 employed or with a job to return to (n = 164,577)
Total medical expenditures >0	0.85	—
Inpatient medical expenditures >0	0.09	—
Total individual medical expenditure (2010 USD) (SD)	4,436.60 (12,378.27)	—
Work loss days, n (SD)	—	4.32 (17.13)
Heart disease	0.11	0.06
Diabetes	0.08	0.05
Stroke	0.03	0.01
High blood pressure w/o heart disease	0.20	0.17
Joint pain	0.33	0.28
Emphysema	0.02	0.01
Asthma	0.09	0.08
Female	0.52	0.47
White	0.70	0.70
Hispanic	0.13	0.13
Black	0.18	0.18
Other race	0.04	0.05
Age 18–34	0.31	0.36
Age 35–44	0.19	0.24
Age 45–54	0.19	0.23
Age 55–64	0.14	0.14
Age 65–74	0.09	—
Age 75 & above	0.08	—
Age 65 & above	—	0.04
No. children 0–5, n (SD)	0.22 (0.55)	0.24 (0.57)
No. children 6–18, n (SD)	0.51 (0.91)	0.58 (0.93)
No. adults 19–64, n (SD)	1.72 (1.05)	1.93 (0.90)
No. adults 65 & over, n (SD)	0.30 (0.62)	0.11 (0.39)
Married	0.54	0.56
Less than high school	0.19	0.14
High school diploma	0.31	0.30
Some college	0.23	0.25
Bachelor’s degree	0.16	0.18
Graduate school	0.10	0.12
Midwest	0.22	0.23
Northeast	0.19	0.19
South	0.36	0.36
West	0.23	0.23
MSA residence	0.82	0.84
Year 2000	0.08	0.09
Year 2001	0.09	0.09
Year 2002	0.09	0.09
Year 2003	0.09	0.09
Year 2004	0.09	0.09
Year 2005	0.09	0.09
Year 2006	0.09	0.09
Year 2007	0.09	0.09
Year 2008	0.09	0.09
Year 2009	0.09	0.09
Year 2010	0.10	0.09
Self-reported (not proxy-reported) data	0.58	0.57
HMO/managed care plan	0.36	0.42
Private insurance	0.61	0.76
Medicare	0.18	—
Medicaid	0.07	—
Uninsured	0.14	—
Public insurance	—	0.08
Hourly wage (2010 USD) (SD)	—	19.51 (13.34)
Weekly work hours, n (SD)	—	39.21 (10.15)
Paid time off to see doctor	—	0.47
Sick pay	—	0.53
Professional occupation	—	0.48
Industry group 1	—	0.12
Industry group 2	—	0.12
Industry group 3	—	0.32
Industry group 4	—	0.07
1–24 employees	—	0.42
25–99 employees	—	0.23
100–499 employees	—	0.19
500 or more employees	—	0.16
Employer size missing	—	0.08
Union member	—	0.11

Data: 2000–2010 Medical Expenditure Panel Survey.

MEPS sample weights are used to ensure that means are nationally representative. The definitions of each industry group are as follows: Group 1 = natural resources, mining, construction, manufacturing; Group 2 = wholesale and retail trade, transportation and utilities; Group 3 = professional and business services, health, education, social services; Group 4 = other services, public administration, military, unclassifiable industry.

Table 2. Per capita medical care expenditures associated with heart disease adults age ≥18.

	All adults, total	All adults, out-of-pocket expenditures	Total medical expenditures by individual’s primary source of health insurance coverage
			Privately insured	Medicare	Medicaid	Uninsured
n	247,700	247,700	132,819	44,799	24,253	45,829
Increase in per capita medical expenditures associated with heart disease	3,217(2,970–3,464)	406(373–439)	3,309(2,939–3,679)	5,232(4,654–5,810)	3,123(2,165–4,081)	1,562(1,113–2,010)
Percentage of total medical expenditures for those with heart disease	28.1%	25.8%	39.0%	36.3%	26.0%	37.1%
	(26.3–29.9)	(24.0–27.6)	(36.0–42.0)	(32.7–39.9)	(19.8–32.2)	(30.9–43.3)

95% CI in parentheses.

Data: 2000–2010 Medical Expenditure Panel Survey.

Standard errors are adjusted for the complex survey design of the MEPS.

Figures are in 2010 dollars.

Table 3. Total medical care costs of heart disease (billions of 2010 USD).

	Total payments (all sources)	Private insurance payments	Medicare payments	Medicaid payments	Total third-party payments	Out-of-pocket payments
2000	81.1	27.7	28.3	4.7	72.4	8.6
	(69.0–93.1)	(22.7–32.8)	(22.3–34.3)	(2.7–6.7)	(61.2–83.5)	(7.2–10.0)
2001	89.9	30.7	32.5	3.8	79.0	10.1
	(79.2–100.3)	(25.4–36.0)	(27.1–37.8)	(2.5–5.2)	(69.3–88.6)	(8.6–11.5)
2002	99.7	32.7	35.7	6.3	87.1	10.7
	(88.2–111.1)	(27.0–38.3)	(29.7–41.8)	(4.1–8.4)	(76.5–97.8)	(9.3–12.2)
2003	108.5	39.0	34.4	5.8	94.6	12.1
	(96.4–120.7)	(32.6–45.3)	(28.8–40.0)	(3.7–7.8)	(83.3–106.0)	(10.6–13.7)
2004	114.4	40.4	39.6	6.4	100.4	12.6
	(100.2–128.7)	(33.6–47.2)	(32.4–46.9)	(4.3–8.5)	(87.2–113.6)	(10.9–14.2)
2005	116.9	40.0	38.9	6.8	101.4	13.8
	(102.9–130.9)	(33.2–46.8)	(32.7–45.2)	(4.4–9.1)	(88.4–114.3)	(12.0–15.6)
2006	106.9	36.3	37.4	4.8	92.8	12.7
	(94.6–119.2)	(30.9–41.7)	(31.3–43.5)	(3.3–6.3)	(81.8–103.9)	(10.9–14.4)
2007	132.5	43.2	48.1	6.2	117.9	12.8
	(117.5–147.5)	(36.4–49.9)	(40.1–56.1)	(4.1–8.2)	(104.0–131.7)	(11.2–14.5)
2008	154.8	52.8	54.2	9.4	135.7	16.0
	(138.9–170.8)	(45.1–60.4)	(45.9–62.5)	(6.2–12.7)	(120.7–150.6)	(14.4–17.7)
2009	168.2	53.9	59.3	10.3	149.5	16.1
	(151.1–185.4)	(46.4–61.4)	(50.2–68.4)	(6.6–14.0)	(133.4–165.6)	(14.1–18.0)
2010	171.3	52.6	62.4	9.1	155.0	14.5
	(154.3–188.4)	(44.8–60.4)	(52.0–72.9)	(5.8–12.3)	(138.5–171.5)	(12.8–16.2)
2010 costs as a percentage  of total payments	14.7%	11.4%	19.8%	10.9%	15.5%	8.7%
	(13.5,15.9)	(10.0–12.8)	(17.4–22.3)	(7.7–14.0)	(14.2–16.9)	(7.8–9.6)
2000–2010 average	122.2	40.8	42.8	6.7	107.8	12.7
	(112.2–132.2)	(36.2–45.5)	(37.2–48.4)	(4.7–8.7)	(98.3–117.3)	(11.5–13.9)
2008–2010 average	164.8	53.1	58.6	9.6	146.7	15.5
	(150.1–179.5)	(46.7–59.5)	(50.5–66.8)	(6.5–12.7)	(132.8–160.7)	(13.9–17.1)

95% confidence intervals in parentheses.

Data: 2000–2010 Medical Expenditure Panel Survey.

Confidence intervals are adjusted for the complex survey design of the MEPS.

Total third-party payments include other federal, state, and local payments that are not part of the federal Medicare or Medicaid programs.

For the 2008–2010 period, MEPS sample weights indicate that the sample generalizes to an overall adult population of 232 million, of whom 153 million were covered by private insurers, 45 million by Medicare, and 22 million by Medicaid.

Table 4. Total medical care cost savings from switching to a high-MUFA diet based on Li et al.⁵ (billions of 2010 USD).

	Total payments (all sources)	Private insurance payments	Medicare payments	Medicaid payments	Total third-party payments	Out-of-pocket payments
2000	12.2	4.2	4.2	0.7	10.9	1.3
	(2.7–21.6)	(0.9–7.4)	(0.9–7.6)	(0.1–1.3)	(2.4–19.3)	(0.3–2.3)
2001	13.5	4.6	4.9	0.6	11.8	1.5
	(3.1–23.8)	(1.0–8.2)	(1.1–8.7)	(0.1–1.1)	(2.7–21.0)	(0.3–2.7)
2002	14.9	4.9	5.4	0.9	13.1	1.6
	(3.4–26.5)	(1.1–8.7)	(1.2–9.5)	(0.2–1.7)	(3.0–23.2)	(0.4–2.9)
2003	16.3	5.8	5.2	0.9	14.2	1.8
	(3.7–28.8)	(1.3–10.4)	(1.1–9.2)	(0.1–1.6)	(3.2–25.1)	(0.4–3.2)
2004	17.2	6.1	5.9	1.0	15.1	1.9
	(3.9–30.4)	(1.3–10.8)	(1.3–10.6)	(0.2–1.8)	(3.4–26.7)	(0.4–3.3)
2005	17.5	6.0	5.8	1.0	15.2	2.1
	(4.0–31.1)	(1.3–10.7)	(1.3–10.4)	(0.2–1.9)	(3.5–27.0)	(0.5–3.7)
2006	16.0	5.4	5.6	0.7	13.9	1.9
	(3.7–28.4)	(1.2–9.7)	(1.2–10.0)	(0.1–1.3)	(3.2–24.7)	(0.4–3.4)
2007	19.9	6.5	7.2	0.9	17.7	1.9
	(4.6–35.2)	(1.4–11.5)	(1.6–12.8)	(0.2–1.7)	(4.0–31.3)	(0.4–3.4)
2008	23.2	7.9	8.1	1.4	20.4	2.4
	(5.4–41.1)	(1.8–14.1)	(1.8–14.5)	(0.2–2.6)	(4.7–36.0)	(0.6–4.3)
2009	25.2	8.1	8.9	1.5	22.4	2.4
	(5.8–44.6)	(1.8–14.4)	(2.0–15.8)	(0.2–2.8)	(5.2–39.7)	(0.5–4.3)
2010	25.7	7.9	9.4	1.4	23.2	2.2
	(6.0–45.4)	(1.8–14.0)	(2.1–16.7)	(0.2–2.5)	(5.4–41.1)	(0.5–3.8)
2010 savings as a percentage of total payments	2.2%	1.7%	3.0%	1.6%	2.3%	1.3%
	(0.5–3.9)	(0.4–3.0)	(0.6–5.3)	(0.2–3.0)	(0.5–4.1)	(0.3–2.3)
2000–2010 average	18.3	6.1	6.4	1.0	16.2	1.9
	(4.3–32.4)	(1.4–10.8)	(1.5–11.4)	(0.2–1.8)	(3.8–28.6)	(0.4–3.4)
2008–2010 average	24.7	8.0	8.8	1.4	22.0	2.3
	(5.8–43.7)	(1.8–14.1)	(2.0–15.6)	(0.2–2.6)	(5.1–38.9)	(0.5–4.1)

95% confidence intervals in parentheses.

Data: 2000–2010 Medical Expenditure Panel Survey.

Confidence intervals are adjusted for the complex survey design of the MEPS and the variance of the relative risk estimate reported in Li et al.⁵.

Total third-party payments include other federal, state, and local payments that are not part of the federal Medicare or Medicaid programs.

For the 2008–2010 period, MEPS sample weights indicate that the sample generalizes to an overall adult population of 232 million, of whom 153 million were covered by private insurers, 45 million by Medicare, and 22 million by Medicaid.

Table 5. Total medical care cost savings from switching to a high-MUFA diet based on Estruch et al.⁶ (billions of 2010 USD).

	Total payments (all sources)	Private insurance payments	Medicare payments	Medicaid payments	Total third-party payments	Out-of-pocket payments
2000	24.3	8.3	8.5	1.4	21.7	2.6
	(8.7–39.9)	(2.9–13.7)	(2.9–14.1)	(0.4–2.5)	(7.8–35.7)	(0.9–4.2)
2001	26.9	9.2	9.7	1.2	23.7	3.0
	(9.8–44.0)	(3.3–15.2)	(3.5–16.0)	(0.3–2.0)	(8.6–38.7)	(1.1–4.9)
2002	29.9	9.8	10.7	1.9	26.1	3.2
	(10.9–48.8)	(3.5–16.1)	(3.8–17.6)	(0.5–3.2)	(9.5–42.7)	(1.2–5.3)
2003	32.6	11.7	10.3	1.7	28.4	3.6
	(11.9–53.2)	(4.2–19.2)	(3.7–17.0)	(0.5–3.0)	(10.4–46.4)	(1.3–6.0)
2004	34.3	12.1	11.9	1.9	30.1	3.8
	(12.5–56.2)	(4.3–19.9)	(4.2–19.6)	(0.6–3.3)	(10.9–49.3)	(1.4–6.2)
2005	35.1	12.0	11.7	2.0	30.4	4.1
	(12.8–57.3)	(4.2–19.8)	(4.2–19.2)	(0.6–3.5)	(11.1–49.8)	(1.5–6.8)
2006	32.1	10.9	11.2	1.4	27.8	3.8
	(11.7–52.4)	(3.9–17.9)	(4.0–18.4)	(0.4–2.5)	(10.2–45.5)	(1.4–6.2)
2007	39.7	12.9	14.4	1.9	35.4	3.9
	(14.6–64.9)	(4.6–21.3)	(5.1–23.7)	(0.5–3.2)	(12.9–57.8)	(1.4–6.3)
2008	46.4	15.8	16.3	2.8	40.7	4.8
	(17.1–75.8)	(5.7–26.0)	(5.8–26.7)	(0.8–4.8)	(14.9–66.5)	(1.8–7.8)
2009	50.5	16.2	17.8	3.1	44.9	4.8
	(18.6–82.3)	(5.8–26.5)	(6.4–29.2)	(0.9–5.3)	(16.5–73.2)	(1.8–7.9)
2010	51.4	15.8	18.7	2.7	46.5	4.3
	(19.0–83.8)	(5.7–25.9)	(6.6–30.8)	(0.8–4.7)	(17.1–75.9)	(1.6–7.1)
2010 savings as a percentage of total payments	4.4%	3.4%	6.0%	3.3%	4.7%	2.6%
	(1.6–7.2)	(1.2–5.6)	(2.1–9.8)	(0.9–5.7)	(1.7–7.6)	(0.9–4.3)
2000–2010 average	36.7	12.3	12.8	2.0	32.3	3.8
	(13.6–59.7)	(4.5–20.0)	(4.7–21.0)	(0.6–3.4)	(12.0–52.7)	(1.4–6.2)
2008–2010 average	49.4	15.9	17.6	2.9	44.0	4.7
	(18.3–80.6)	(5.8–26.0)	(6.4–28.8)	(0.9–4.9)	(16.3–71.8)	(1.7–7.6)

95% confidence intervals in parentheses.

Data: 2000–2010 Medical Expenditure Panel Survey.

Confidence intervals are adjusted for the complex survey design of the MEPS and the variance of the hazard ratio estimate reported in Estruch et al.⁶.

Total third-party payments include other federal, state, and local payments that are not part of the federal Medicare or Medicaid programs.

For the 2008–2010 period, MEPS sample weights indicate that the sample generalizes to an overall adult population of 232 million, of whom 153 million were covered by private insurers, 45 million by Medicare, and 22 million by Medicaid.

Table 6. Per capita work loss days and work loss productivity cost associated with heart disease for working adults age ≥18.

Work loss days	Work loss productivity cost (assuming half day lost)	Work loss productivity cost (assuming full day lost)
3.5(2.7–4.3)	254(197–311)	507(394–622)

95% confidence intervals in parentheses.

Data: 2000–2010 Medical Expenditure Panel Survey.

Standard errors are adjusted for the complex survey design of the MEPS. Productivity costs are in 2010 USD.

Table 7. Total work loss productivity cost of heart disease and cost savings from switching to a high-MUFA diet based on Li et al.⁵ and Estruch et al.⁶ (billions of 2010 USD).

	Productivity loss from heart disease (half day)	Savings from high-MUFA diet		Productivity loss from heart disease (full day)	Savings from high-MUFA diet
		Li et al.^5 (half day)	Estruch et al.^6 (half day)		Li et al.^5 (full day)	Estruch et al.^6 (full day)
2000	2.3	0.3	0.7	4.7	0.7	1.4
	(1.7–3.0)	(0.1–0.6)	(0.2–1.2)	(3.4–5.9)	(0.1–1.3)	(0.4–2.3)
2001	2.5	0.4	0.8	5.0	0.8	1.5
	(1.8–3.2)	(0.1–0.7)	(0.2–1.3)	(3.5–6.5)	(0.1–1.4)	(0.5–2.5)
2002	2.4	0.4	0.7	4.8	0.7	1.4
	(1.6–3.2)	(0.1–0.7)	(0.2–1.2)	(3.3–6.3)	(0.1–1.3)	(0.4–2.5)
2003	2.8	0.4	0.8	5.5	0.8	1.7
	(2.0–3.5)	(0.1–0.8)	(0.3–1.4)	(4.0–7.1)	(0.2–1.5)	(0.5–2.8)
2004	3.1	0.5	0.9	6.2	0.9	1.8
	(2.2–3.9)	(0.1–0.8)	(0.3–1.6)	(4.5–7.8)	(0.2–1.7)	(0.6–3.1)
2005	2.9	0.4	0.9	5.8	0.9	1.8
	(2.1–3.8)	(0.1–0.8)	(0.3–1.5)	(4.1–7.6)	(0.2–1.6)	(0.5–3.0)
2006	2.7	0.4	0.8	5.5	0.8	1.6
	(2.0–3.5)	(0.1–0.7)	(0.3–1.4)	(4.0–7.0)	(0.2–1.5)	(0.5–2.8)
2007	2.9	0.4	0.9	5.9	0.9	1.8
	(2.2–3.7)	(0.1–0.8)	(0.3–1.5)	(4.4–7.4)	(0.2–1.6)	(0.6–3.0)
2008	4.0	0.6	1.2	7.9	1.2	2.4
	(3.0–5.0)	(0.1–1.1)	(0.4–2.0)	(5.9–9.9)	(0.2–2.1)	(0.8–4.0)
2009	3.7	0.6	1.1	7.4	1.1	2.2
	(2.7–4.6)	(0.1–1.0)	(0.4–1.8)	(5.5–9.2)	(0.2–2.0)	(0.7–3.7)
2010	3.9	0.6	1.2	7.7	1.2	2.3
	(2.9–4.8)	(0.1–1.0)	(0.4–1.9)	(5.8–9.6)	(0.2–2.1)	(0.8–3.9)
2000–2010 average	3.0	0.5	0.9	6.0	0.9	1.8
	(2.3–3.7)	(0.1–0.8)	(0.3–1.5)	(4.6–7.4)	(0.2–1.6)	(0.6–3.0)
2008–2010 average	3.8	0.6	1.1	7.7	1.1	2.3
	(3.0–4.7)	(0.1–1.0)	(0.4–1.9)	(5.9–9.4)	(0.2–2.1)	(0.8–3.8)

95% confidence intervals in parentheses.

Data: 2000–2010 Medical Expenditure Panel Survey.

Confidence intervals are adjusted for the complex survey design of the MEPS and the variance of the relative risk estimate reported in Li et al.⁵ and Estruch et al.⁶.

For the 2008–2010 period, MEPS sample weights indicate that the sample generalizes to an adult working population of 157 million.

Li Y, Hruby A, Bernstein AM, et al. Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease. J Am Coll Cardiol 2015;66:1538-48

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Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N England J Med 2013;368:1279-90

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