Health care utilization and the associated costs attributable to cardiovascular disease in Ireland: a cross-sectional study
Authors: Stamenic Danko , Fitzgerald Anthony P. , Gajewska Katarzyna A. , O’Neill Kate N. , Bermingham Margaret , Cronin Jodi , Lynch Brenda M. , O’Brien Sarah M. , McHugh Sheena M. , Buckley Claire M. , Kavanagh Paul M. , Kearney Patricia M. , O’Keeffe Linda M. 
Published: September 2023

Background

Cardiovascular diseases (CVD) are the leading cause of mortality and disability globally. An ongoing reform of the Irish healthcare system is underway with a focus on preventing avoidable CVD and lessening its burden to society. However, the high rates of healthcare service use attributable to CVD and the associated costs have not been adequately quantified in Ireland. We examined the difference in health service utilisation and costs for populations with and without CVD in Ireland for the period preceding the reform.

Methods

Secondary data analysis of the first wave (2009-2011) of The Irish Longitudinal Study on Ageing (TILDA), a nationally representative study of community-dwelling adults in Ireland aged 50+. CVD was defined as having a self-reported doctor’s diagnosis of myocardial infarction, angina, heart failure, stroke, atrial fibrillation or transient ischaemic attack. Participants self-reported the utilization of healthcare services over the 12 months preceding the interview. Negative binomial regression with average marginal effects (AME) was used to model the effect of CVD on healthcare service utilisation. We estimated the incremental number of general practitioner (GP) and outpatient department (OPD) visits, accident and emergency department (A&E) attendances and hospitalisations in population with CVD relative to population without CVD and calculated the associated costs. Analyses were adjusted for socio-demographic confounders and other chronic conditions. Using census 2022 data on the total number of people aged 50+ living in Ireland, we estimated the total incremental costs attributable to CVD at the population level.

Results

Among 8113 participants, the prevalence of CVD was 18.2% (95% confidence interval (CI): 17.3, 19.0). Participants with CVD reported higher utilization of all healthcare services. In adjusted models, having CVD was associated with incremental 1.19 (95% CI: 0.99, 1.39) GP and 0.79 (95% CI: 0.65, 0.93) OPD visits over the past year. There were twice as many incremental hospitalisations in males with CVD compared to females with CVD (AME: 0.20 (95% CI: 0.16, 0.23) for males vs AME: 0.10 (95% CI: 0.07, 0.14) for females), but no difference was observed with respect to the incremental use of other healthcare services by gender or age groups. The incremental cost of healthcare service use in this population relative to the population without CVD were an estimated €352.2 million (95% CI: €272.8, €431.7), 93% of which was due to use of secondary care services.

Conclusion

There are substantial use of healthcare services and costs associated with CVD in Ireland, with hospital admissions being the biggest contributor to costs. While a shift towards the management of uncomplicated CVD cases in primary care is currently being implemented in Ireland, continued efforts aimed at CVD primary prevention and management are required to contain healthcare service costs. Further research on gender-disparities in the use of healthcare services attributable to CVD is warranted.