The cost of hypertension: heart attacks, strokes and public expenditure
The question
Is there an impact of the economy on the control of blood pressure and its complications at population level?
Answer: The most recent ISTAT surveys reveal that in Italia cardiovascular diseases, which account for 31% of all deaths, continue to represent the leading cause of mortality in the country. In detail, 75% of deaths from cardiovascular diseases are attributable to risk factors: over 60% of deaths are attributable to metabolic risks (37%), such as dyslipidaemia, hypertension and diabetes.
To complete the picture, data obtained by the Istituto Superiore di Sanità (Iss) reveal that in Italia about 50% of the population in the 40-69 age bracket is at medium/high cardio-metabolic risk, i.e. at risk of incurring a major cardiovascular event, such as a myocardial infarction or a stroke, in the next 10 years. All this has made it possible to quantify the very high annual economic burden at individual and collective level, both in terms of direct and indirect costs, in the order of more than EUR 21 billion.
Specifically, direct costs are those arising from medical therapies, rehabilitation care, diagnostic investigations and hospital stays for patients; indirect costs are mainly related to lost productivity, both for patients and caregivers, a direct consequence of the debilitating nature of many cardiovascular diseases.
The reasons for the loss of productivity are linked to initial hospitalisation and sickness absence after discharge. In particular, an event such as a stroke forces the individual into long periods of absence from work, a reduction in work capacity and often even permanent withdrawal from the labour market, with a major impact on the welfare and social security system. The real tragedy is that so many heart attacks and strokes could be avoided by not smoking, being physically active, eating healthily and controlling blood pressure and cholesterol. The evidence could not be stronger.
All this imposes the need to strengthen prevention interventions, of early diagnosis for these subjects, starting with communication and awareness campaigns, as specified earlier, addressed to citizens through the media and professionals of the National Health System, (SSN) in addition to population screening programmes. All this in the knowledge that prevention makes it possible to implement timely interventions, increasing the effectiveness of treatments, with obvious savings in terms of both direct and indirect costs.