Objective: To estimate the economic burden of coronary heart disease in the UK using both direct and indirect costs. Design and setting: A prevalence based approach was used to assess coronary heart disease related costs from the societal perspective. Patients: All UK residents in 1999 with coronary heart disease (ICD 9 codes 410-414 and ICD10 codes I20-I25). Main outcome measures: Direct health care costs were estimated from spending on prevention, accident and emergency care, hospital care, rehabilitation, and drug treatment. Direct non-health service costs were estimated from data on informal care. "Friction period" adjusted productivity costs were estimated using the human capital approach from lost earnings attributable to coronary heart disease related mortality and morbidity. The friction period is the period of employees' absence from work before the employer replaces them with other workers. Failure to adjust for this factor would overstate production loss. Results: Coronary heart disease cost £1.73 billion to the UK health care system in 1999: £2.42 billion in informal care and £2.91 billion in friction period adjusted productivity loss; 24.1% of production losses were attributable to mortality and 75.9% to morbidity. The total annual cost of all coronary heart disease related burdens was £7.06 billion, the highest of all diseases in the UK for which comparable analyses have been done. Conclusions: Coronary heart disease is a leading public health problem in the UK in terms of the economic burden from disease. Cost estimates would be substantially understated if informal care/productivity costs were excluded. C oronary heart disease, defined in this study as International classification of diseases ICD 9 codes 410-414 and ICD10 codes I20-I25 (ischaemic heart diseases), is the leading single cause of death in the UK and one of the most important causes of years of life lost before the age of 65. . At the age of 40, lifetime risk for developing coronary heart disease in the West is 50% in men and 33% in women. 3 In economics, a cost or burden of illness study estimates the resources consumed in disease prevention, detection, and treatment. This type of study provides a potentially useful decision making aid for setting priorities in health care research, and has been conducted for many diseases in the UK.4-18 Previous attempts to estimate the economic impact of coronary heart disease in the UK have focused only on cost items attributed to the health care system, the so called direct health care costs. [19][20][21][22] However, there are also substantial direct non-health service costs from the care of coronary heart disease patients provided by family members and friends, the so called "informal care" costs. The economy also suffers from productivity loss, because a high percentage of patients with coronary heart disease and the people who care for them would otherwise be in paid employment. The burden of productivity loss falls on employers as lost working days and on the government as incapacity benefi...

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