Abstract 4146987: Forecasting US state-level health expenditures for cardiovascular diseases through 2050

Introduction: The cost of cardiovascular care in the United States has increased rapidly but detailed future cost forecasts are unavailable. To address this gap, we estimated conservative future health expenditures for specific cardiovascular diseases and types of care through the year 2050 for each US state and nationally. Methods: We used data from the Institute for Health Metrics and Evaluation’s Disease Expenditure Project for the years 2000-2019, which captures >85% of all US healthcare spending at the age, sex, cause of death, risk factor, type of care, and state-specific level. Input data included insurance claims, drug prescriptions, emergency department visits, inpatient stays, ambulatory care visits, and nursing facility stays. Using population forecasts from the Global Burden of Disease study and holding utilization and cost rates constant, we estimated, in 2019 dollars, cardiovascular expenditures for 2020-2050 per age, sex, type of care, cause, and state to forecast conservative lower bounds for costs. Results: Total cardiovascular spending in the US was forecasted to rise from $324 billion in 2019 to $460 billion in 2050. Across all types of care, inpatient care expenditure was the highest and remained so at 42.6% of total spending by 2050. Spending was forecasted to rise the most for nursing facility care and home healthcare, from 11.8% to 13.9% and 7.1% to 8.2% of the total respectively. By 2050, spending was highest for ischemic heart disease at $110 billion, up from $79 billion in 2019, followed by heart failure at $102 billion, up from $64 billion in 2019. As a proportion of overall spending, heart failure was forecasted to increase from 19.7% in 2019 to 22.1% in 2050. Over the same period, spending on treating obesity was forecasted to rise from $13 to $15 billion, but as a proportion of overall cardiovascular spending, this represented a fall of 0.8% due to increases for other conditions. Conclusion: Cardiovascular expenditures in the US were projected to increase by at least 41.9% by 2050, using conservative projection methods. The largest increases across types of care were for those associated with an aging population. Updates to forecasts will be needed as data on the impact of the COVID pandemic and new obesity pharmacotherapies become available and modelling methods improve. Large increases in the absolute cost of cardiovascular care in the US over the next 3 decades will require changes in health policy and system reform.