Better CVD prevention spurred spending dip for Medicare patients

Spending growth per Medicare beneficiary has slowed considerably since 2005, and 56 percent of that decline can be linked to reduced spending on cardiovascular disease and related risk factors, researchers reported Feb. 4 in Health Affairs.

The study found Medicare spending per capita rose 3.8 percent annually from 1992 to 2004 but dropped to a 1.1 percent annual growth rate from 2005 to 2012. The reductions in spending—compared to if it had progressed at a linear rate throughout the study—saved the average person nearly $2,900 per year in 2010 U.S. dollars, lead author David M. Cutler, PhD, and colleagues wrote. More than $1,600 of that reduction was attributed to lower spending for cardiovascular and cerebrovascular disease and risk factors including hypertension, high cholesterol and diabetes.

Across the entire elderly population in the U.S., the $2,900-per-person savings would amount to $120 billion each year, with about half of those savings coming from Medicare, according to a Harvard University press release.

“This is the first time, to my knowledge, anyone has shown that some forms of medical care can save money,” Cutler, a Harvard economics professor, said in the release. “You see that claim all the time. But in terms of widespread preventive care saving money … we’ve never had that example before.”

Cutler and colleagues matched spending data from the Medicare Beneficiary Survey—which includes medical claims complete with diagnoses—to patients with similar health and socioeconomic status using another national survey which captures disease prevalence.

They estimated 51 percent of the spending slowdown for CVD and related risk factors was tied to the increased use of cardiovascular medicines. Other trends they identified as the study period progressed include:

  • Lower CVD prevalence—from 1999 until 2005, the prevalence of major CVD increased by 1.4 percent each year. From 2005 to 2012, it fell by 0.8 percent annually.
  • Fewer acute events—Primary event rates decreased by 4.8 percent annually during the first part of the study and 7.1 percent annually during the second part of the study. For those with prior events, the corresponding declines were 1.7 percent each year in the first period and 4.1 percent annually in the second.
  • Improved risk factor control—From 1999 to 2014, control of hypertension and cholesterol rose by nearly 25 percent for people with those conditions, while the proportion of diabetics with controlled diabetes rose 12 percent.

“It is not that new therapies to treat cardiovascular disease risk were developed during this period,” the authors wrote. “Rather, the therapies that were previously available are now used much more frequently. We estimate that greater use of preventive cardiovascular disease medications accounted for half of the reduction in cardiovascular disease spending, or about one-quarter of the overall medical care spending slowdown.”

The findings underscore the importance of continued efforts to promote patient adherence and compliance with preventive cardiovascular drugs, as well as appropriate prescribing patterns among clinicians. Cutler and colleagues also noted several “important medications” became generic between 1999 and 2012, which also contributed to savings.

The researchers pointed out not all spending categories experienced a slowdown—the cost of vaccinations and cancer screenings, for example, increased $391 per person more than expected based on the pace set before 2005.

But thanks largely to improvements in preventing cardiovascular disease, total spending among Medicare beneficiaries was billions lower than the figure it was previously trending toward. And there’s plenty of room left for improvement, according to Cutler et al.

“Even though great progress has been made in preventing cardiovascular disease, there is still a long way to go,” they wrote. “Only 55-60 percent of people have their risk factors under control. Changes in definitions of people at risk might also lead to additional savings for other groups.”