Innovation in Heart Failure Treatment Life Expectancy, Disability, and Health Disparities

OBJECTIVES The goal of this study was to illustrate the potential benefit of effective congestive heart failure (CHF) treatment in terms of improved health, greater social value, and reduced health disparities between black and white subpopulations. BACKGROUND CHF affects 5.7 million Americans, costing $32 billion annually in treatment expenditures and lost productivity. CHF also contributes to health disparities between black and white Americans: black subjects develop CHF at a younger age and are more likely to be hospitalized and die of this disease. Improved CHF treatment could generate significant health benefits and reduce health disparities. METHODS We adapted an established economic-demographic microsimulation to estimate scenarios in which a hypothetical innovation eliminates the incidence of CHF and, separately, 6 other diseases in patients 51 to 52 years of age in 2016. This cohort was followed up until death. We estimated total life years, quality-adjusted life years, and disability-free life years with and without the innovation, for the population overall and for race-and sex-defined subpopulations. RESULTS CHF prevalence among 65-to 70-year-olds increased from 4.3% in 2012 to 8.5% in 2030. Diagnosis with CHF coincided with significant increases in disability and medical expenditures, particularly among black subjects. Preventing CHF among those 51 to 52 years of age in 2016 would generate nearly 2.9 million additional life years, 1.1 million disability-free life years, and 2.1 million quality-adjusted life years worth $210 to $420 billion. These gains are greater among black subjects than among white subjects. CONCLUSIONS CHF prevalence will increase substantially over the next 2 decades and will affect black Americans more than white Americans. Improved CHF treatment could generate significant social value and reduce existing health disparities. (C) 2018 by the American College of Cardiology Foundation.