Abstract
Background: Besides inflation, the recent expansion of health insurance coverage and the limited regulation of drug pricing in the US has caused per capita pharmaceutical expenditures to increase substantially. We aim to examine the proportion of health care spending used on drugs and its association with burden of comorbidity among adults with cardiovascular disease (CVD).
Methods: Using the 2012 Medical Expenditures Panel Survey (MEPS), adults aged 40 years with an ICD-9 diagnosis of CVD (410, 413, 414, 428, 433, 434, 435, 436, 437, 427, 440, 443, or 447) (n=1,846) from the medical condition file were studied. The burden of comorbidity was estimated using the Charlson Comorbidity Index (CCI). We used the two-part econometric model to estimate the mean healthcare and pharmaceutical expenditures and it association with CCI. The mean proportion of health care spending for pharmaceuticals was estimated and tested for trend across CCI using the variance-weighted least squares. All analyses took into account the study’s complex survey design and were weighted to the U.S. population.
Results: Approximately 18.9 million adults aged 40 years (mean age[SD]: 69[15] years; 44% females) had a diagnosis of CVD; 37% had CCI=1, 26% had CCI=2. Overall, healthcare expenditures among adults with CVD was $248.4 billion; 26.1% ($64.8 billion) of which was spent on pharmaceuticals. Both absolute total health care expenditures and pharmaceutical expenditures significantly increased proportionally with CCI (table). However, pharmaceutical expenditures expressed as proportion of total health care spending did not increase with greater co-morbid disease burden (p-trend =0.198).
Conclusion: Pharmaceutical expenditure is a significant contributor of healthcare spending (>1 in every 3 US dollars spent) among adults with established CVD. It is imperative to critically assess interplay of such issues as pricing and appropriate utilization of pharmaceutical agents to mitigate increasing healthcare spending among those with CVD.
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