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 For the study, researchers focused on adults diagnosed with the most
common type of heart disease, known as atherosclerosis, which
happens when fats, cholesterol and other substances build up on
artery walls.
When these patients did as much as they could to avoid so-called
modifiable risk factors for heart disease - inactivity, obesity,
smoking, high cholesterol, elevated blood pressure and diabetes -
their total average annual pharmaceutical expenditures were $1,400,
the study found.
But patients who did little to modify these risk factors had total
average annual pharmaceutical expenditures of $4,516, researchers
report in the Journal of the American Heart Association.
"Individuals who are unwilling to modify their lifestyles so as to
have a favorable risk factor profile would most likely resort to
medications to control the risk factors," said lead study author Dr.
Joseph Salami of the Center for Health Care Advancement and Outcomes
at Baptist Health South Florida in Coral Gables.
"A person getting little or no exercise has a higher risk of
obesity," Salami said by email. "Someone obese is more likely to
have diabetes, high blood cholesterol and hypertension."
For the study, researchers examined 2012 and 2013 data from the
Medical Expenditure Panel Survey, a national snapshot of spending
based on surveys of almost 76,000 American patients, families,
doctors and employers. The total pharmaceutical costs, reported in
2013 dollars, include patients' out-of-pocket fees like co-payments
and co-insurance as well as the portion of the tab covered by
insurance or other sources, Salami said.
Among the survey participants, 4,248 adults aged 40 or older had
atherosclerosis, representing about 21.9 million people in the U.S.
population. They were 68 years old on average, and 45 percent were
women.
Overall, average annual drug costs for each participant were $3,432.
About a third of this was for cardiovascular disease drugs and
another 14 percent was spent on diabetes medicines.
The remaining expenditures - more than half of the total - were for
non-cardiovascular disease and non-diabetes drugs and were
significantly associated with the modifiable risk factors, the study
team notes.
Nationwide, this adds up to annual drug spending of $71.6 billion
for patients with atherosclerosis, researchers estimated.
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One limitation of the study is that it might overestimate
expenditures because it's possible some people prescribed
medications for heart disease might be taking them for other
reasons, the authors note. Researchers also lacked data on the type
of insurance patients' had or for individual characteristics of
patients, doctors or pharmacists that might influence drug costs.
Costs should be considered in the context of how well treatments
work, and the study doesn't address this, noted Dr. Aaron Kesselheim,
a researcher at Brigham and Women’s Hospital and Harvard Medical
School in Boston who wasn't involved in the study.
"In some cases, the benefit that patients get from these
non-pharmacologic therapies may be much more substantial than the
benefit that drug therapy can offer," Kesselheim said by email. "In
other cases, the drug might be more helpful."
The study also isn't a controlled experiment designed to prove that
people will spend less on drugs when they make lifestyle changes to
reduce their risk of heart disease, said Julie Schmittdiel of the
Kaiser Permanente Northern California Division of Research in
Oakland.
"It does suggest there is promise that addressing modifiable health
behaviors will reduce costs," Schmittdiel, who wasn't involved in
the study, said by email.
Knowing this might help motivate some patients to make changes, said
Stacie Dusetzina, a pharmacy researcher at the University of North
Carolina at Chapel Hill who wasn't involved in the study.
"I think many of us realize how hard these risk factors are to
modify," Dusetzina said by email. "But having incentives that
include feeling better and saving money may help with motivation."
SOURCE: http://bit.ly/2sRwQJm Journal of the American Heart
Association, published online June 9, 2017.
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